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Benefits

Medical Insurance
How the Health Savings Account (HSA) Works
A Health Savings Account (HSA) is a tax-advantaged account that you own. In 2017, FotoKem will make quarterly HSA contribu ons
of $200 per employee. These contribu ons can total as much as $800 per employee for the year. FotoKem’s contribu on will be
deposited in your account whether or not you decide to make your own contribu ons. In addi on to FotoKem’s contribu on, you
may elect to make contribu ons into your account up to IRS maximums. IRS maximums for 2017 are $3,400 for employee coverage
and $6,750 for family coverage. If you are 55 years of age or older in 2017, the IRS also permits you an addi onal catch-up
contribu on of $1,000. The por on of your paycheck that you contribute to your HSA will be taken out before you pay federal
income taxes, Social Security taxes and most state taxes (excluding state taxes in AL, CA and NJ). Any contribu ons you make can
be increased or decreased over the course of the year.

You can decide how to manage your money. The money in your HSA is yours to save and spend on eligible health care expenses
whenever you need it, whether in this plan year or in future plan years. You can use the funds in your account to pay tax-free for
qualifying out-of-pocket Medical, Dental and Vision expenses such as deduc bles, coinsurance and copays. Your account balance
earns interest and the unused balance rolls-over from year to year. The money is yours to keep even if you leave FotoKem, no
longer par cipate in a high deduc ble health plan (like the HSA PPO Medical plan), or re re. You may con nue to make
contribu ons to your HSA if you enroll in another qualified high deduc ble health plan, or elect COBRA con nua on coverage of
your HSA PPO Medical plan coverage if your employment terminates.

Eligible HSA Expenses Include:

Medical Dental Vision Other
Doctors Podiatrists Den sts Optometrists COBRA
Prescrip on Drugs Psychiatrists Orthodon sts Ophthalmologists Premiums
Hospital Psychoanalysts Periodon sts Exams Long-Term Care
Lab work Psychotherapists Teeth Cleaning Glasses Premiums
X-Rays Ar ficial Limbs X-Rays Contact Lenses Medicare
Nurses Insulin Treatment Fluoride Lasik Surgery Premiums
Ambulance Alcoholism Treatment Treatments
Durable Medical Steriliza on
Equipment (wheel Acupuncture
chairs, pumps, hearing Chiroprac c
aids, crutches, etc.)

Ineligible HSA expenses include expenses that are not medical or health related as well as cosme c surgery.

HSA Tax Savings Comparison Without the HSA With the HSA

Gross Annual Pay $45,000 $45,000
Employee pre-tax HSA contribu ons used to pay for annual healthcare Not Elected $2,500
expenses (deduc bles, copays, prescrip on drugs, dental expenses, vision
expenses, etc.)

Taxable Gross Income $45,000 $42,500
Payroll Taxes (at 30%) $13,500 $12,750
Employee-Funded HSA Bank Account $0 $2,500

Net Pay $31,500 $32,250
Annual Savings with Pre-Tax HSA Deduc on $0 $750

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