1 2015 HSA Guide

2015 HSA Plan Quick GuideThe HSA Plan consists of two parts that work together to give you more control over how you receive and pay for medical care and services, both now and in the future: the Health Savings Account and the HSA Medical Plan.

This guide provides you with details on both parts of the plan to assist you in making this plan work for you and your family. The HSA Plan enables you to:

• Setupandcontributepre-taxdollarstoaHealthSavingsAccount(HSA),andreceiveacontributionfromEmory, to pay for eligible medical, dental and vision services.

• ParticipateinanEmory-sponsoredmedicalplanwiththelowestemployeecontributions.• Seekandreceivepreventivecareatnocosttoyou(EHNandIn-Network).• Receiveincentivesforyourparticipationinhealthyactivities.• Supportyoureffortstostayhealthywithaccesstoinformation,programsandhealthtopicsaffectingyouandyour

family.• Havetheflexibilitytochoosehowyoupayandfromwhomyoureceivemedicalcareandservices.

Read more inside!

2015 HSA Guide 2

The HSA Plan

The Health Savings Account

EnrollingintheHSAPlanallowsyoutotakeadvantageofthetaxsavingsfeaturesofaHealthSavingsAccount.

• Emorycontributestax-freefundstoyourHSAuponyour enrollment.

• Youandyourcoveredspouse/SameSexDomesticPartner(SSDP)cancompleteincentiveactivitiesandreceiveanadditionalEmorycontribution.

• Youcanalsocontributeonapre-taxbasisthroughpayroll deduction.

• Withdrawals to pay for eligibleexpensesarenottaxable.TheIRSdoesimposepenaltiesifyouusethefundsforineligibleexpenses.Save your receipts and your Explanation of Benefits (EOB).

• What you do not spend stays in your account for you to use in the future.

• HSA contributions are owned by you and are portable intheeventthatyouleaveEmory.

The HSA Plan provides a more non-traditional approach to managing your health care than Emory’s POS Plan. The HSA Plan gives you more choice and flexibility while emphasizing and supporting you and your family’s efforts to stay healthy. Like the POS Plan, you have financial protection for medical costs through a deductible, co-insurance and an out-of-pocket maximum. But unlike the POS Plan, this plan provides you with an account, which is funded in part by Emory, that gives you the flexibility to choose how to spend your health care dollars.

In order to qualify for Health Savings Account:

1. You must be enrolled in the HSA Plan.

2. You cannot be claimed as a dependent on someone else’s tax return.

3. You cannot be covered by a spouse’s Flexible Spending Account (FSA).

4. You cannot be covered by any other medical plan, including Medicare A and/or B.

Compare

It is important to note that employee contributions

(bi-weekly premiums) for the HSA Plan are

significantly lower than employee contributions for

the POS Plan. To see how the HSA Plan compares

with the POS Plan, use the Plan Selection & Cost

Estimator Tool located online at www.ourehc.org.

3 2015 HSA Guide

Opening your Account

• When you elect to establish a Health Savings Account, theCustomerIdentificationProcess(CIP)beginsinorder to open your account.

• Aetna/PayFlex,theadministratorfortheHealthSavingsAccount, may contact you directly via email or letter to request any additional information needed. Your timely response will facilitate the process.

• Until the account is open, no contributions will be applied to the account.

• Once the account is open, you will be mailed a welcome letteranddebitcard(PayFlexCard).

• RegisteryourHSAfollowingthedirectionsinyourwelcome letter.

• Designateabeneficiary:

– Ifyourspouseisthedesignatedbeneficiary,theHSA will be treated as your spouse’s HSA after your death.

– Ifthedesignatedbeneficiaryisnotyourspouse,theaccount stops being an HSA and the value of the HSAbecomestaxabletothebeneficiary.

Emory’s Annual Contribution

• IfyouareenrolledintheHSAPlanwithindividualcoverageonJanuary1,Emorywillmakea$400 contributiontoyourHealthSavingsAccount.Ifyoucoveranydependents(spouse/samesexdomesticpartnerorchildren),youwillreceiveanadditional$400foratotalannualmaximumcontributionof$800.

• For employees who enter the plan at any time after January1,Emory’scontributiontotheHSAwillbeprorated based on your enrollment date.

• Emory’scontributionsaremadeonthefirstpayrollofthe month following enrollment.

Emory’s Incentive Contribution

• You can earn incentives that are added to your HSA by participating in and completing various healthy activities(seetheIncentivessectiononpage7tolearnmore).Themaximumincentiveamountthatcanbeearned and contributed to an HSA during the plan year is $800(withacoveredspouse/SSDP).Toensurethatincentive funds are available to pay for your medical expenses,participateinandcompleteyourincentivesearly in the year.

• Emoryprocessesallincentivescompletedbythe15thofthemonthforincentivepaymentonthenextpayperiod.

• Incentives must be completed between January 1, 2015 and November 15, 2015 to be eligible for 2015 incentives.

The HSA Plan

2015 HSA Guide 4

The HSA is All About Choice!

If you have funds available in your HSA, you can

use them to pay your eligible medical expenses.

Or, you can choose to save your HSA dollars and

pay eligible expenses yourself. HSA funds are not

forfeited at the end of the plan year; your HSA

dollars will continue to be available for you to use.

The HSA Plan

Your HSA Contributions

• TheIRSestablisheslimitsfortheamountthatcanbecontributedeachyeartoanHSAbyyouandEmory:

– For2015,thelimitsare$3,350forindividualcoverageand$6,650ifyoucoverdependents.

– Ifyouareovertheageof55,anadditional$1,000“catch-up”contributionisallowed.

• Youcanmakepre-taxcontributionsthroughpayrolldeduction. The amount of your contribution can be changedbycontactingtheEmployeeResourceCenter.

• After-taxcontributionscanbemadetoyouraccountbytransferring funds from your bank account.

• IfyourtotalHSAcontributionsexceedannualmaximums,youwillbetaxedontheexcess.

• You can make changes to your method of contribution, as well as your contribution amount at any time during the year; payroll deduction changes are processed for thenextavailablepayroll.

• Contributions are allowed until you begin participating in Medicare or you no longer qualify for a Health Savings Account.

THE HSA -- A TRIPLE TAX ADVANTAGE

tax-free money outUse your HSA to pay for medical expenses or pay for them yourself and save your HSA funds for later.

tax-free money inEmory contributes $400 (or $800). You can earn up to $400 (or $800) in incentives. You can contribute additional pre-tax money too!

tax-free savingsUnused funds remain in your account and grow with tax-free interest. They roll over year-to-year. There is no use-it or lose-it rule.

HSA Debit Card

5 2015 HSA Guide

Managing your Account

• RegisterandlogontoAetnaNavigatorat www.aetna.com.

– YourHSAwillbelistedunder“AccountsandFunds.”

– You can see the account activity including contributions and distributions.

• PayFlexMobileallowsyoutoreceivenotifications,submit claims and more.

• Complete incentive activities to receive additional funds to your account.

• UseyourPayFlexcardtopayyourmedical,dentalorvisionexpenses,orpayoutofpockettosaveHSAfunds for future use.

• Balancesover$1,000canbeinvestedinBNYMellonoptions.Investmentearningsaretax-free.

• IRSPublication969providesinformationonHealthSavings Accounts.

The HSA Plan

Accessing Your HSA Funds

• Aetna/PayFlex MasterCard Debit Card – You will receiveaPayFlexMasterCarddebitcardinyourwelcome kit from Aetna. Once activated, you may use the debit card just as you would a debit card tied to a savings or checking account, as long as you use it topayeligibleexpenses.Youmaymakepaymentsbyphone, online or in person with the debit card.

• Make a Payment – When you make a payment online usingPayFlex,youcanchoosetohaveachecksentdirectly to your provider.

• Reimbursement–Whenyoupayeligibleexpenses,youmay reimburse yourself from your HSA by transferring fundstoyourbankaccount.The“linking”processwillrequireaone-timeverificationofyourcheckingaccount.Detailsonthisprocessareincludedinyourwelcome letter.

• Funds must be available in your account on the day you make payment or initiate reimbursement.

• HSAfundsmaynotbeusedtopayorreimburseSSDPexpensesorexpensesforachildwhoisnolongerataxdependent, even if covered on your medical insurance plan.

• BesuretokeepyourreceiptsandExplanationofBenefits(EOBs).

2015 HSA Guide 6

The HSA Plan

Eligible Expenses • HSAsaretobeusedforeligiblemedicalexpenses,

suchasdeductiblesandco-insurancefordoctorvisits, hospitalization, and surgery for you and your eligible dependents. You may also use your HSA for prescription drugs, dental care and certain vision expenses.

• Ingeneral,youmaynotuseyourHSAtopayhealthcare premiums while an active employee. However, thereareexceptionsforCOBRAenrollees,andforthosereceivingunemploymentbenefitsorwhoareage65andolder.YoumayalsouseHSAfundsforMedicarepremiumsandlong-termcare(LTC)premiums,ifapplicable.

• AnyHSAfundsusedforineligibleexpensesaresubjecttoincometaxanda20%IRStaxpenalty.

• IRS Publication 502 provides information on qualified medical expenses.

Coordinating HSA with a Flexible Spending Account• IfyouelectaHealthcareFlexibleSpendingAccount

(FSA),itwillbeaLimitedFSAadministeredbyAetna/PayFlex.

• You can receive reimbursement for dental and vision expenses.

• Once you have met the HSA annual deductible, medical expensescanbereimbursedfromtheFSA.

• Submit a claim for reimbursement; the limited FSA will notbeonyourPayFlexcard.

• Remember,FSAfundsdonotrolloverfromyeartoyear.

FSA Balances and IRS Restrictions on HSAs InaccordancewithIRSregulations,ifyouareanewenrolleeintheHSAPlanfor2015(i.e.switchingfromthePOSPlan)andyouhaveabalanceina2014HealthcareFlexibleSpendingAccount(asofDecember31,2014),youare not eligible to contribute funds to an HSA or receive any fundsinyourHSAuntilApril1,2015.ThisincludesEmory’sannual contribution, incentives earned from wellness activities, or contributions you make to your HSA. The April 1,2015datestillappliesevenifyourHealthcareFSAaccountbalancereaches$0atanearlierpointduring2015.

Additionally, if you have a balance in your FSA as of December31,anymedicalexpensesincurredpriortoApril1,2015arenoteligibleforreimbursementwithHSAfunds.ExpensesmustbeincurredafterApril1,2015inorderto use HSA funds. You will need to consider whether or notyouwillhaveanFSAbalanceonDecember31whenmaking your decisions about enrolling in the HSA Plan including making any contributions to an HSA through payrolldeduction.Ifyouhavea$0balanceinyour2014HealthcareFSAasofDecember31,2014,youareHSAeligibleonJanuary1,2015andyou(andEmory)canmakecontributionstotheaccountandeligiblemedicalexpensescan be paid with your HSA funds.

While you may cover a child up to age 26

or a SSDP under the HSA Plan, qualified

medical expenses are those incurred by you,

your spouse, and all dependents you claim

on your tax return. Refer to IRS Publication

969 for more details.

7 2015 HSA Guide

The HSA Plan

Incentives

Whether you select the HSA Plan or the POS Plan, you can lower your overall medical costs by participating in healthy activities.IfyouenrollintheHSAPlan,yourincentiveswillbeacontributiontoyourHSA.IfyouenrollinthePOSPlan,your incentives will be a credit against your deductible. Refertothechartbelowforincentiveamounts.Eachenrolledemployeeandspouse/same-sexdomesticpartneris eligible for the same incentive amounts. All incentive activities must be completed after January 1, 2015 to be eligible for 2015 incentive(s).

Types of Incentives

Aetna’s Simple Steps Online Health Assessment Earna$25giftcardforcompletingAetna’sSimpleStepsonline health assessment. The health assessment is a brief online questionnaire to help you assess your health habits andtoprovideyouwithnextstepstoahealthieryou.Please note that this incentive activity must be completed before any other incentives can be received. Forexample,ifyoucompletetheHealthyLifestyleCoachingandgetyourannualcheck-up,butdon’tcompletethehealthassessment, you will not receive your incentives for the other two activities. Be sure to complete the health assessmentearlyin2015soyoucangetcreditforallofyourincentive activities.

Annual Check-up One of the most important things you can do for your healthistoscheduleanannualcheck-up(orwellness/preventiveexamvisit).With a focus on preventive care, an annualcheck-upincludesanageandgenderappropriatehistory,anexamination,areviewofriskfactorsandplansto reduce them, and the ordering of appropriate immunizations, screenings, etc.Forwomen,awell-adult(orwell-woman)visitwillcountforthis$100incentive.Ifyouhaveanannualcheck-upscheduledforlate2014,youmaywanttoconsiderreschedulingitforearly2015soitcountstowardyour2015incentives.

Please note that free, onsite biometric screenings will not be offered at Emory in 2015, but you are encouraged to get “your numbers” at your annual check-up. If you don’t have a primary care physician, you can find one by calling Emory Health Connection at: 404-778-7777 or 1-800-75-EMORY, or going to: www.aetna.com/docfind/custom/emory.

Aetna’s Healthy Lifestyle Coaching You have access to your own personal, telephonic health coachtohelpyoureachyourhealth-relatedgoals.Workonone or more of the following: weight management, tobaccocessation,stressmanagement,nutrition,fitnessand preventive health. By participating, you can receive $100uponcompletionofthethirdcoachingsession.

Disease Management Program Ifyouhaveachroniccondition,theDiseaseManagementProgram can provide support and assistance and help you improveyouroverallhealth.Diseasescanincludediabetes,high blood pressure, high cholesterol and more. You can be referred to a disease management program by a physician, through another program, through Aetna, or you can refer yourself. The program involves a series of calls with a nurse whowillworkwithyoutoeffectivelymanageyourcondition. Upon four completed phone calls with your nurse,youwillqualifyfora$200incentive.

2015 Incentive Amounts(Employee/Spouse/SSDP)

Aetna’s SimpleSteps Online Health Assessment $25.00(gift card)

Healthy Lifestyle Coaching $100.00

Annual Check-up (preventive exam) $100.00

Disease Management $200.00

Maximum Incentive Total $425.00

2015 HSA Guide 8

The HSA Plan

The HSA Medical PlanTheHSAMedicalPlanfeaturesadeductible,co-insuranceandanannualoutofpocketmaximumtoprovidefinancialsecurity.

Annual Deductible

• Youarefinanciallyresponsibleformeetingthedeductible before the plan pays for any eligible expenses.YoucanusethefundsthataccumulateinyourHSAtopayeligiblemedical,dentalandvisionexpensesincurred by you, your spouse, and dependents you claim onyourtaxreturn.Thedeductibledependsonthecoverage level you have elected.

• EmployeeOnlyCoverage:

AnnualDeductible-$1,350(EHNorIn-Network).Youpaythefirst$1,350ineligibleexpenses.YoucanfundtheseexpensesbyutilizingyourHSA.TheOut-of-Networkdeductibleis$2,000.

• Employee+Spouse/SSDP,Employee+Child(ren)andFamily level Coverage:

AnnualDeductible-$2,700(EHNorIn-Network).Youpaythefirst$2,700ineligibleexpenses.YoucanfundtheseexpensesbyutilizingyourHSA.TheOut-of-Networkdeductibleis$4,000.

Co-InsuranceOncethedeductiblehasbeensatisfied,theplanprovidescoverageforeligibleexpensesthroughco-insurance.Thehighest levels of coverage under the plan are by utilizing the EmoryHealthcareNetwork(EHN)orbyobtainingservicesfromIn-Networkproviders(AetnaNationalNetwork).

• EHN–Planpays90%ofeligiblemedicalexpense, youpay10%

• In-Network–Planpays80%ofeligiblemedicalexpense,youpay20%

• Out-of-Network–Planpays60%ofeligiblemedicalexpense,youpay40%

Annual Out-of-Pocket Maximum

TheHSAPlanalsoprovidesfinancialprotectionforyouandyour family in the event of a catastrophic illness or injury throughtheannualout-of-pocketmaximum.Ifyourshareofexpenses(deductibleandco-insurancepaidbyyou)duringtheyearreachestheOut-of-PocketMaximumallremainingeligibleexpensesarecoveredbytheplanat100%,includingEmergencyRoomvisitsandprescriptiondrugs.

• $3,000foremployeeonlycoverage(EHNorIn-Network);$6,000Out-of-Network

• $6,000forEmployee+Spouse/SSDP,Employee+Child(ren)orFamilylevelcoverage(EHNorIn-Network);$12,000Out-of-Network.

9 2015 HSA Guide

Check up on Medications

It’s a good idea to occasionally check up on

your medications’ coverage tiers. Sometimes

drugs change tiers. To be certain which tier

your medications are on, call CVS/caremark

at 866-601-6935.

Tier Co-insurance30-Day Retail

Maximum

Zero 0% $0

1 10% $25

2 20% $35

3 30% $70

4 40% $100

Mail-order maximum co-pays are 2½ x the retail amount

Prescription Drug Coverage

• ThepharmacybenefitmanagerfortheHSAPlanisCVS/caremark.Youmayfillprescriptionseitherataretailpharmacy(30daysupply)orbyusingmailorderservice(90daysupply).

• Youmustpayallout-of-pocketcostsforprescriptiondrugs until you meet your annual deductible. After you meet the deductible, you will pay the applicable co-insuranceamountundertheHSAPlan,uptothe30-day“RetailMaximum.”Mailorderis2xtheretailmaximum.

• You can use your HSA to pay for prescription drugs.

• Preventive medications are covered under Tier Zero andthedeductibleandco-insurancedonotapply.

• One very important change to note is that if you take any maintenance prescription medications to treat certain ongoing medical conditions, you will need to fillyourprescriptionsinoneofthreeways:throughCVS/caremark’smailorderservice,ataCVSretailpharmacylocation(atthemail-servicecost),oratanEmorypharmacy.PleasebeawarethatifyouattempttofillamaintenancedrugatapharmacyotherthanCVSorEmory,youwillbechargedthefullretailcostonyourthirdattempttorefill.Whilethismaycausesomeinconvenience, it is a necessary measure to help control the overall cost of the plan.

The HSA Plan

The table below shows what your responsibility is once yourdeductibleissatisfied.Forexample,ifthetableshowsco-insuranceis20%,theplanwillpay80%ofthecostoftheprescription drug and you are responsible for the other 20%.However,thereisfinancialprotectionbuiltintotheprescriptiondrugbenefitinthatyouwillneverpaymorethanthe30-day“RetailMaximum,”outlinedinthetablebelow:

2015 HSA Guide 10

How the HSA Plan WorksTheHSAPlanencourageshealthylivingbyproviding100%coverageforpreventivecarewhenyouuseEmoryHealthcareproviders(EHN)orIn-Networkproviders(AetnaNationalNetwork).Theplanalsogivesyoumorecontroloverhowyoureceiveandpayforhealthcareservices.Likeatraditionalplan,theHSAPlanhasadeductible,co-insuranceandanout-of-pocketmaximumtoprovidefinancialprotectionintheeventofaseriousillnessorinjury.AdistinctadvantagewhenenrollingintheHSAPlanistheabilitytosetupahealthsavingsaccountandcontributepre-taxtoiteachyear.

1 2 3

Emory contributes $400 if you are enrolled in employee only coverage; $800 if you cover any dependents (spouse/SSDP or children). Employees 55 years of age and over can add up to an additional $1,000 contribution to the HSA maximums for catch-up contributions. Once the annual out-of-pocket maximum is satisfied, the plan pays 100% of all remaining eligible expenses during the plan year, including Emergency Room visits and prescription drugs.

EmoryContributes

$4001

or$8001

You EarnIncentives

Up To$400 (or $800)

YouContribute

Any AmountUp ToPlan

Maximum

Maximum Contributions – All Sources:$3,3502 or $6,6502

Health Savings Account (HSA)Emory Contribution + Your Earned Incentives

+ Your Contributions

Deductible

Co-Insurance

Out-of-Pocket Maximum

Remaining HSA Balance

Use your HSA funds to pay for eligible medical expenses.Total Possible HSA Contributions2:• $3,350 (Employee Only)• $6,650 (Employee + Spouse/SSDP, Employee + Child(ren) or Family)

You pay all eligible expenses until the deductible is satisfied.You may use funds in your HSA to meet your deductible.• $1,350 (Employee Only–In-Network); $2,000 (Out-of-Network)• $2,700 (Employee + Spouse/SSDP, Employee + Child(ren) or Family–In-Network); $4,000 (Out-of-Network)

Once the deductible is satisfied, for services you pay:• 10% in the Emory Healthcare Network (EHN)• 20% in the Aetna National Network (In-Network)• 40% Out-of-Network

If your expenses paid annually exceed:• $3,000 (Employee Only–In-Network); $6,000 (Out-of-Network)• $6,000 (Employee + Spouse/SSDP, Employee + Child(ren) or Family); $12,000 (Out-of-Network). Then the plan pays 100%3

Unused HSA funds will continue to be availablefor future use on eligible medical, dental and visionexpenses.

Pre

vent

ive

Car

e C

ove

red

at

100%

(EH

N o

r In

-Net

wor

k)

Money in the HSA will be invested

in a money market fund.

11 2015 HSA Guide

DonnaSingle Coverage — Employee Only

MeetDonna!Herhealthexpensesthroughout the year are usually low. Other than getting her annual check-up,shetypicallyhasfewmedicalexpenses.Sinceshedoesnot usually spend much on health care,DonnalikestheideaofreceivingfundingfromEmorytomeet her other health care needs duringtheyear.Donnatakesadvantageof100%In-Networkcovered preventive care by getting herwell-womancheck-up.Becauseanannualcheck-upnowcountsasanincentiveactivity,shereceives$100.Shealsoreceivesa$25giftcardforcompletingherAetnaSimpleStepsonlinehealthassessment.(Completionofthehealthassessmentisrequiredinordertogettheotherincentive).Additionally,shehasoneotherofficevisitandfillsoneprescriptioneachmonth from Tier 2 at a retail pharmacy.

YeAR One

Donna’s HSA ContributionsEmory’s contribution . . . . . . . . . . . . . . . . . . . . . . . . . . $ 400Received incentive (annual check-up) . . . . . . . . . . . . . $100

Donna’s Contribution ($100 per month x 12 months) . . . . . . . . . . . . . . . . . . . $1,200

Total HSA funds available . . . . . . . . . . . . . . . . . . . $1,700

Donna’s Medical expensesTier 2 prescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 420In-Network office visit. . . . . . . . . . . . . . . . . . . . . . . . . . $125Annual check-up (preventive care is paid by the plan at 100%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0

Total expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 545

Donna’s TotalsHSA funds available. . . . . . . . . . . . . . . . . . . . . . . . . . $1,700Annual deductible satisfied . . . . . . . . . . . . . . . . . . . . . $545 Annual out-of-pocket maximum satisfied. . . . . . . . . . . $545

With the HSA Plan, Donna can pay for her $545 in expenses by using her HSA. The $1,155 remaining in her HSA after her expenses paid will be available for future eligible medical expenses.

YeAR TwO

Donna’s HSA ContributionsHSA balance carried over from previous year. . . . . . . . $1,155Emory’s contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . $400Received incentive (annual check-up) . . . . . . . . . . . . . . $100

Total HSA funds available in year two . . . . . . . . . . $1,655

Donna’s Medical expensesTier 2 prescription . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $420In-Network office visit. . . . . . . . . . . . . . . . . . . . . . . . . . . $125Annual check-up (preventive care). . . . . . . . . . . . . . . . . . . $0

Total expenses in year 2. . . . . . . . . . . . . . . . . . . . . . . $ 545

Donna’s TotalsHSA funds available. . . . . . . . . . . . . . . . . . . . . . . . . . . $1,655 Annual deductible satisfied . . . . . . . . . . . . . . . . . . . . . . $545 Annual out-of-pocket maximum satisfied. . . . . . . . . . . . $545

With the HSA Plan, Donna again used her HSA to cover her $545 of medical expenses during the plan year.

The $1,110 remaining in her HSA at the end of year two will be available for future use.

YeAR THRee

Donna’s HSA ContributionsHSA balance from previous year . . . . . . . . . . . . . . . . $1,110Emory’s contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . $400Received incentive (annual check-up) . . . . . . . . . . . . . . $100

Total HSA funds available in year three . . . . . . . . $1,610Annual deductible to meet. . . . . . . . . . . . . . . . . . . $1,350

For year three, Donna has accumulated enough funds in her HSA to cover her annual deductible should she incur a large health expense.

HSA Plan Examples

2015 HSA Guide 12

YeAR One

Smith Family HSA Contributions

Emory’s contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$800Cindy completed an incentive (annual check-up) . . . . . . . . . . . . . . . . .$100Andrew completed an incentive (annual check-up) . . . . . . . . . . . . . . .$100Cindy completed an incentive (disease management program) . . . . . .$200Smith Family Payroll Contribution. . . . . . . . . . . . . . . . . . . . . . . . . . . $1,800

Total HSA funds available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $3,000

Smith Family Medical expenses Smiths Paid Plan Paid HSA Funds Used

Joe has an emergency room visit that results in eligible charges totaling $750. $750 $0 $0

One office visit for Cindy’s Asthma Condition. $150 $0 $0

Asthma Prescriptions $1,200 $0 $0

Two In-Network Well-Adult and two Well-Child visits at $125 each totaling $500. The Smiths’ responsibility is $0 because preventive care is covered at 100%. $0 $500 $0

Total expenses $2,100 $500 $0

The Smiths’ have HSA available funds totaling $3,000. They have decided to save their HSA funds for future eligible medical expenses. Alternatively, the Smiths could have decided to pay all of their expenses incurred using their HSA, and paid $0 out of their own pocket. Then, they would start year two with an HSA balance of $900 ($3,000 - $2,100 = $900) from year one’s balance rolling forward.

The Smith FamilyFamily Coverage — 2 Adults, 1 Child

MeettheSmiths!AndrewandCindyandtheirthree-yearoldson, Joe, have a variety of planned and unplanned health expensesthroughouttheyear.Eachyeartheyallnormallygetanannualphysicalexam.Thefamilyestimatesatleastfiveofficevisitsperyear—twowell-childandtwowell-adultvisits,plusanofficevisitforCindy’schronicasthmacondition.CindyandAndrewbothget$100eachinincentivemoneyforcompletingtheirannualcheck-ups.Cindy,becauseshehasanasthma condition, referred herself to Aetna and completed the disease management program to earn an additional incentive of$200.Plus,bothCindyandAndreweachreceived$25giftcards for completing their Aetna SimpleSteps online health assessment.(Completionofthehealthassessmentisrequiredinordertogettheotherincentives).

HSA Plan Examples

13 2015 HSA Guide

Frequently Asked Questions

How do I deposit funds into my HSA? FundstoyourHSAcancomefrom(1)Emory’sannualcontribution,(2)incentivesyouand/oryourspouse/SSDPearnand(3)contributionsyouand/oryourspousemake.Your contributions to the HSA, including contributions fromyourspouse,canbemadethroughpre-taxpayrolldeductions,ormaybemadeafter-taxbytransferringfundsfromyourbankaccount.SSDPscannotmakecashcontributions to your HSA, but can contribute to HSAs they establish on their own.

nOTe: If you enroll in the HSA Plan for 2015 and have a balance in a 2014 Healthcare Flexible Spending Account (as of December 31, 2014), you are not eligible to contribute funds to an HSA or receive any funds in your HSA until April 1, 2015. This includes Emory’s annual contribution, incentives earned from wellness activities, or contributions you make to your HSA. The April 1, 2015 date still applies even if your Healthcare FSA account balance reaches $0 at an earlier point during 2015.

Can I use the funds in my HSA to pay medical expenses for my SSDP and/or my SSDP’s dependent child(ren)? No.TheIRSdefinesdependenteligibilityforfilingeligibleexpensesthroughaccountssuchasHSAsandFSAs(flexiblespendingaccounts).WhileEmoryallowsemployeestocoverSSDPs(andtheirdependentchildren)throughEmory-sponsoredmedicalplans,HSAsandFSAsmustadheretofederally-establishedguidelines.SSDPsandtheirchildrencurrentlydonotmeetIRSguidelinesforeligibledependents.However,SSDPsmayestablishtheirownHSAs(independentoftheemployee’sHSA),andmayusetheirownHSAstocovereligibleexpensesforthemselvesandtheirchildren.However,eligibleexpensesforSSDPsandtheir children will be covered under the HSA medical plan oncethedeductiblehasbeensatisfied.EmorywillmonitorIRSupdatesandmakechangesinaccordancewithIRSregulations.

How do I get a new or additional debit card for myself or my dependents?

Ifyouneedareplacementcardoranadditionalcardforyourself or your dependent, you should request one through Aetna/PayFlexbycalling888-678-8242.

I am a new employee and want to enroll in the HSA Plan. Will I receive the entire annual Emory contribution? No.ThecontributionsyoureceivefromEmorytoyourHSA will be prorated based on when you activated your

HSA.Forexample,ifyouarehiredonFebruary10andenroll in employee only coverage, you receive the annual contributionfortheMarch–Decembertimeframe–that’s10outof12monthsor83%oftheyear($400x.83=$332).

I am over 55 years of age. Can I contribute more to my HSA? Yes,ifyouareanEmoryemployeeandareovertheageof55,youcanmakeanadditional$1,000in“catch-up”contributionstoyourHSA.Whenincludingcatch-upcontributions,theannualcontributionmaximumsareincreasedto$4,350forindividualcoverageand$7,650forfamily coverage.

How do I access the beneficiary form for the HSA? BeneficiarydesignationformsareavailableontheAetnaNavigatorwebsite(www.aetna.com).Afteryoulogintoyour account, click the Tools & Resources tab at the top of the page.

Can I still have an FSA if I am enrolled in the HSA Plan? Yes.YoucanenrollinalimitedHealthcareFlexibleSpendingAccount(FSA)evenifyouareenrolledintheHSAPlan.You may use the limited FSA to pay for dental and vision expensesandformedicalexpensesonceyourdeductiblehasbeenmet.Remember:withanFSA,thefundsmustbeusedbytheendofthegraceperiod(March15orthefollowingyear)ortheyareforfeited.

When will I see my incentive in my HSA account?

Emoryprocessesallincentivescompletedbythe15thofthemonthforincentivepaymentonthenextpayperiod.

For more information, contact:

• Employee Resource Center 404-686-6044 ehc.hr/benefits@emoryhealthcare.org

• Aetna 800-847-9026 www.aetna.com/docfind/custom/emory