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medIcal plan optIons

anthEM BluE CroSS luMEnoS hSa PPo 3000
The Anthem Blue Cross Lumenos HSA PPO 3000 medical plan combines a high deductible health plan (HDHP)
with a special, tax qualified Health Savings Account (HSA). A Health Savings Account is a tax-advantaged medical
savings account available to United Pacific employees who are enrolled in the high deductible health plan. The HSA
money can be used for any out-of-pocket medical expenses. The funds contributed to the account are not subject
to federal income tax at the time of deposit. These funds will roll over and accumulate from year to year. If you
choose to leave the organization, the funds will go with you for future medical expenses.

Within the Anthem Lumenos HSA PPO 3000 medical plan, you will have the freedom to choose your doctor without
the requirement of selecting a Primary Care Physician (PCP). To maximize your benefits in the plan, you may use
a network provider, whose negotiated rates provide richer levels of benefits. You may also obtain services using a
non-network provider, but you may be required to pay out-of-network amounts.

In selecting this plan, United Pacific will establish your Health Savings Account and contribute money on your behalf.
Your HSA is like a personal, tax-free savings account, designed specifically for health care expenses, that earns
interest. Unused money will accumulate and roll over from year to year.
Here’s an overview of how the Anthem Lumenos HSA PPO 3000 plan works:
• Enroll in the Anthem Lumenos HSA PPO 3000 plan for medical coverage
• United Pacific will establish a Health Savings Account (HSA) for you
• You will receive a Welcome Packet from Health Equity at your home address with detailed instructions
• Under the HSA section, 4th bullet, please replace sentence with:
United Pacific will make HSA contributions to your Health Savings Account. Employees enrolled in the HSA PPO
plan as employee only will receive a $28.85 per pay period contribution ($750 maximum per year). Employees who
have dependents enrolled in the plan will receive $57.69 per pay period contribution ($1,500 maximum per year)
• In addition to the United Pacific contribution, employees may also contribute into their Health Savings Account,
up to the IRS maximum. In 2018, the IRS maximum is $3,450 for employee coverage and $6,900 for family coverage.
(These amounts include the employer contribution noted above.) In addition, if you are over the age of 55, you are
also permitted an additional “catch-up” contribution of $1,000 in 2018
• Any additional contributions that employees make to the Health Savings Account will be withheld prior to income
taxes, Social Security taxes and most state taxes (excluding AL, CA and NJ for state taxes)
• The money in your HSA is yours. The money can be saved and rolled over from year to year, or can be used on
eligible health care expenses

Additional information on a Health Savings Account:
• The funds in your account can be used to pay for qualifying out-of-pocket Medical,
Dental and Vision expenses, such as deductibles, coinsurance and copays
• The account balance earns interest
• The unused balance rolls over from year to year
• The money is yours to keep, even if you leave your job at United Pacific, or no longer participate in a high deductible health plan
anthEM BluE CroSS Solution PPo 1500
The Anthem Blue Cross PPO (Preferred Provider Organization) allows you the flexibility to direct your own health care,
both in and out of the network. It is preferred that you select physicians within the Anthem network and receive care
with “In-Network” physicians. A greater percentage of your costs will be paid by the plan by staying “In-Network”. Going
“Out of Network”, or using non-network providers, comes with additional costs, or even the filing of your own claims.

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