Page 10 - QSC Benefits Guide 7-18 CALIFORNIA PRINT

MEDICAL INSURANCE

How the Option 1 Health Savings Account (HSA) PPO Works

The opportunity to establish and contribute to a Health Savings Account is available when you elect the HSA PPO medical
plan option. It’s like a personal, tax-free savings account for health care expenses that earns interest. Any unused money
rolls over from year to year.

In 2018, QSC will make the following HSA contributions into The money in your HSA is yours to save and spend on eligible
your account: health care expenses whenever you need it, whether in this plan
• Employee: $46.16 Biweekly / $1,200 Annual year or in future plan years. You can use the funds in your account
• Family: $92.31 Biweekly / $2,400 Annual to pay tax-free for qualifying out-of-pocket Medical, Dental and
Vision expenses such as deductibles, coinsurance and copays.
If you are a first time enroller into the HSA PPO plan, QSC Your account balance earns interest and the unused balance
will front load the entire annual contribution amount, or a rolls-over from year to year. The money is yours to keep even if
prorated amount if mid-year. you leave QSC, no longer participate in a high deductible health
plan (like the HSA PPO), or retire. You may continue to make
In addition to QSC’s contribution, you may elect to make contributions to your HSA if you enroll in another qualified high
contributions into your account up to IRS maximums. Annual deductible health plan, or elect COBRA continuation coverage
IRS maximums for 2018 are: of your HSA PPO coverage if your employment terminates.
• Employee: $3,450
• Family: $6,900 About HSA Bank Account
• Catch-up if you are 55 years of age or older: $1,000 When you update your cart with your HSA enrollment on
UltiPro, the following will take place:
The portion of your paycheck that you contribute to your • An HSA account will be initiated on your behalf
HSA will be taken out before you pay federal income taxes, • Money will be deposited into your HSA from two sources:
Social Security taxes and most state taxes (excluding state QSC contributions and the amount you elect to contribute
taxes in AL, CA and NJ). In addition, any contributions you
make to your HSA can be increased or decreased over the Note: Claims incurred prior to your HSA bank account
course of the year. establishment are not eligible for reimbursement from your

HSA funds.

Examples of Eligible HSA Expenses

• Providers (Doctors, Specialists, Nurses) • Providers (Optometrists,
• Prescription Drugs Ophthalmologists)
• Inpatient Hospital Services • Exams
• Laboratory & X-Ray • Glasses
Medical • Emergency Services Vision • Contact Lenses
• Acupuncture / Chiropractic • Lasik Surgery

• Providers (Dentists, Specialists,
Orthodontists) • COBRA Premiums
• Teeth Cleaning • Long-Term Care Premiums
Dental • Dental Treatment Premiums • Medicare Premiums
• Orthodontia

Examples of Ineligible HSA Expenses
Ineligible HSA expenses include expenses that are not medical or health related as well as cosmetic surgery.
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