NationalONE $2700-100%

The High Deductible Health Plan

(HDHP)

and Health Savings Account (HSA)

July 1, 2019

2

District 622 Health Plan Offerings

In-Network BenefitsNationalOne

$200-$25

NationalOne

$2700-100% HSA

Available to: All groups

Clerical, Education

Assistants, Local 70,

Non Units,

Paraprofessionals,

Principals

Deductible$200 individual

$600 family

$2,700 individual

$5,400 family

Medical Out-of-pocket

Maximum

$500 individual

$1,000 family

$2,700 individual

$5,400 family

Prescription Out-of-

pocket Maximum

$500 per person

$750 per family

Combined with Medical

Out-of-Pocket Maximum

Lifetime maximum Unlimited Unlimited

Preventive health care 100% coverage 100% coverage

Office Visits

Urgent Care$25 copay

100% coverage after

deductible

Convenience Clinics

(Retail Clinics)$0 copay

100% coverage after

deductible

Preferred Benefits based on completion of Wellness incentive

Provider network and drug formulary the same for all plans

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In-Network BenefitsNationalOne

$200-$25

NationalOne

$2700-100% HSA

Inpatient,

Outpatient hospital,

Ambulance

100% after

deductible100% after deductible

Emergency Room $75 copay 100% after deductible

Durable medical

equipment

100% after

deductible100% after deductible

Home health care 80% after

deductible100% after deductible

Retail pharmacy:

-- Generic preferred

-- Brand preferred

-- Non-preferred

34 day supply/100

units

$8 copay

$16 copay

$32 copay

31 day supply

100% after deductible

Mail order pharmacy 2 copays for a 90

day supply100% after deductible

District 622 Health Plan Offerings

Preferred Benefits based on completion of Wellness incentive

Provider network and drug formulary the same for all plans

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How does it work?

High Deductible Plan with a

Reimbursement Account (HSA)

2. HealthPartners

processes the

claim, applies

their discount and

sends Explanation

of Benefits to

provider and you.1. You seek

medical care,

your provider

submits the

charges to

HealthPartners.

3. Provider

sends you bill

for amount

you owe.

4. You pay the

doctor using

provided checks

or Further debit

card.

5

HSA OverviewClerical, Education Assistants, Non-Unit, Paraprofessionals,

Principals

What is a Health Savings Account (HSA)?Financial account that is owned by an individual

Associated with a High Deductible Health Plan

(HDHP)

Contributions to the account are to pay for

current and future medical expenses

No “use it or lose it”, unused funds rollover

Interest earned is tax free

Investment opportunities

Portable

Beneficiary can be named to account

Post age 65 non-medical distributions without

penalty

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HSA Employee Advantages

Control over the account

Ability to contribute tax free $ to HSA account

2019: single $3,500, family $7,000

Catch up (age 55+) $1,000

Rollover provides opportunity to save for future health

care expenses

Tax-exempt withdrawals for qualified medical

expenses not covered by the health plan

Interest and earnings grow tax free w/ investment

opportunities

Portability

Post 65 non-medical withdraws

This is the employee’s account and the entire

balance belongs to the employee, regardless of your

present or future employment and/or who deposited

the funds.

Using your account

We make it easy to access your funds

Debit Card

Direct

deposit

File a

claim

online, fax

or mail

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Smart Card

Accepted everywhere Visa is accepted

No ATM access

No Fees for Debit Card

Spouse or additional cards for no cost

Some substantiation required (VEBA)

SAVE RECEIPTS AND EXPLAINATION OF BENEFITS

(EOB)!

Debit Card – Gives you choices

Online Member Service Center

Register with the site to:

View your account 24/7 via PC, Tablet or mobile

phone

Request reimbursement for out of pocket expenses

Check balance

View account activity

Request additional debit cards, add/change

beneficiaries, manage investment funds

Managing your account is easy with

hellofurther.com

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View your account 24/7 via PC, Tablet or

mobile phone

Request reimbursement for out of pocket

expenses

Check balance

View account activity

Request additional debit cards

Manage investment funds

Member MobileMore than an App, full website enabled experience

from any mobile device

We’re here to helpOur expert, friendly service team is here to answer

your questions

1.800.859.2144651.662.5065

Monday thru Friday

7 a.m. to 8 p.m. CST

hellofurther.comYour Online Member

Service Center

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Who is Eligible for an HSA?

Anyone who is:

• Covered by the High Deductible Health Plan,

NationalONE $2700-100%

• Not enrolled in Medicare

• Not covered under other health insurance*

Cannot be covered by any other health insurance

that reimburses you for health expenses you incur,

unless it is another HSA-qualified HDHP.

• Not another person’s tax dependent

*Other health insurance does not include: specific

disease or illness insurance, accident, disability,

dental care, vision care and long-term care

insurance

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Eligibility Scenarios -- Acceptable Situations:

Single employee enrolled

in HDHP

no medical flex

no HRA/VEBA

limited medical flex

limited HRA/VEBA

suspended HRA/VEBA

not on Medicare

Married employee enrolled in

HDHP

not enrolled in spouse’s medical

plan

spouse doesn’t have a traditional

medical flex

spouse doesn’t have an

HRA/VEBA

spouse has an HRA/VEBA that is

limited to spouse’s expenses

limited HRA/VEBA

suspended HRA/VEBA

not enrolled in Medicare

Spend Down Approach:

Employee elects HDHP and wishes to spend down their

HRA/VEBA balance. The first of the month following when the

VEBA balance is $0, the participant could establish an HSA

account, assuming they are not enrolled in the traditional flex

plan or have any other coverage that would make them

ineligible for an HSA account.

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Some scenarios Eligibility Scenarios -- Problem Situations:

Single employee enrolled in non HDHP, doesn’t suspend or

limit existing VEBA

Gets married, want to enroll in HDHP and HSA.

Can’t start HSA as long as HRA/VEBA has funds remaining or

until next plan year when the HRA/VEBA can be limited or

suspended

Single employee enrolled in non HDHP, doesn’t have

HRA/VEBA, but elects traditional medical flex

Gets married, want to enroll in HDHP and HSA.

Can’t start HSA until next flex plan as flex creates HSA

ineligibility

Married employee enrolled in non HDHP, doesn’t suspend or

limit existing HRA/VEBA

Wishes to enroll in HDHP and HSA due to spouse plan

change/cost.

Can’t start HSA as long as HRA/VEBA has funds remaining or

until next plan year when the HRA/VEBA can be limited or

suspended

Married employee enrolled in non HDHP, doesn’t have VEBA,

but elects traditional medical flex

Wishes to enroll in HDHP and HSA due to spouse plan

change/cost.

Can’t start HSA until next flex plan as flex creates HSA

ineligibility

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Distribution Rules

Distributions are tax-free if they are taken for “qualified medical expenses”

Accounts can only be used for expenses that are incurred on or after the date the account was established

Funds can be used for expenses from a prior year, as long as the expenses incurred on or after the date the account was established

Distributions can be taken for qualified medical expenses

for the following people:

The account holder (employee covered by the HDHP)

Spouse of account holder (even if not covered by the

HDHP)

Dependent Children

HSA: Tax Dependents of that individual

For individuals age 65 and older, HSA distributions can be

used for non-qualified medical expenses without facing

the 20 percent penalty

However, income taxes will apply for non-medical

distributions

This rule is regardless of whether the individual is

enrolled in Medicare

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Qualified Medical Expenses

The IRS defines expenses that are considered “qualified medical

expenses” for HSA distributions

Expenses must be primarily to treat or prevent a physical or

mental defect or illness

If you use HSA funds for expenses beyond what the IRS defines as

qualified, you will be subject to income tax on the distribution

and an additional 20 percent penalty

Examples of qualified medical expenses:

Most medical care that is subject to your deductible (copays,

coinsurance, doctor visits, inpatient or outpatient treatment, etc.)

Prescription drugs

Over-the-counter drugs, only if you obtain a prescription

Insulin (with or without a prescription)

Dental and vision care

Select insurance premiums

COBRA, qualified long-term care insurance, health insurance

premiums paid while receiving unemployment benefits,

health insurance after you turn 65 except for a Medicare

supplemental policy

Examples of not considered “qualified medical expenses”:

Insurance premiums (other than the exceptions listed above)

Over-the-counter drugs (unless a prescription is retained from a

physician – insulin is an exception)

Cosmetic procedures such as teeth whitening

A full list of qualified medical expenses is available at www.hellofurther.com or

from the Benefits office

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Which plan is a good fit for me?

For the high deductible examples, the assumption is

that average office visit costs $110

Remember:

Routine Preventative Physicals are covered 100%

under all plans

200-25 Plan has a prescription copay of $8 generic

preferred, $16 brand preferred and $32 non

preferred; an office visit copay of $25 and a $200

per person deductible (maximum of $400 per

family).

The HSA plan has a deductible of $2,600 per

person and a maximum of $5,200 per family.

Assuming Preferred Benefits resulting from

completed of the Wellness Incentive Program

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HSA ContributionClerical, Education Assistants, Non-Unit, Paraprofessionals,

Principals--HSA $2600-100%

Where applicable, effective July 1, 2018 District

Contributions to the HSA will be the surplus of the District

Contribution compared to the health plan premium.

Please note for full-time Clerical, Driver/Custodians, Non-

Units and Principals contributions are made each paycheck

July through June; 24 paychecks. For all other groups,

contributions are made each paycheck October through

May; 16 paychecks.

Employee Group Family Single

CLERICAL-10 mo, Full-time (Hired before 8/7/92) $9.44 $60.67CLERICAL-10 mo, Full-time (Hired after 8/7/92) $0.00 $60.67CLERICAL-11 mo, Full-time (Hired before 8/7/92) $9.44 $60.67CLERICAL-11 mo, Full-time (Hired after 8/7/92) $0.00 $60.67CLERICAL-12 mo, Full-time $9.44 $60.67DRIVER/CUSTODIAN-12 mo, Full-time $9.44 $60.67DRIVER-STUDENT CONTACT DAY $0.00 $60.67EDUCATION ASSISTANT $0.00 $0.00NON-UNITS-FAMILY CAP $9.44 $60.67NON-UNITS-NURSES $0.00 $60.67NON-UNITS-SINGLE CAP $0.00 $60.67PARAPROFESSIONALS $0.00 $35.65PRINCPALS $9.44

$60.67

District Contribution to the

HSA (monthly)

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HSA Contribution

Each year, the IRS sets contribution limits

These limits are for the total funds contributed,

including company contributions, your contributions

and any other contributions

You are allowed to contribute the entire year’s limit

whenever you first become eligible for the HSA (even if

that is in December)

However, you must remain eligible for at least 12

months after that date, or you will be subject to taxes

and penalties on the amount you contributed

For individuals ages 55 and older, the IRS allows

additional “catch-up contributions”

Eligible individuals may contribute an extra $1,000 for

the calendar year (for 2019)

2018

Individual $3,500

Family $7,000

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200-25

Plan

2700/5400 HSA

Plan

($728 District

Contribution to HSA)

*Annual premiums $1,410 $0^

Office visits $50 $220

Rx drugs $32 $240

Total estimated

maximum costs$1,492 $460

Reimbursable

expenses in HSAn/a $460

Cost after HSA

reimbursement$1,492 $0

HSA Balance n/a $268 ($728-$460)

Scenario 1: Low Healthcare User-SingleHDHP HSA (Clerical, EA, Local 70, Non Units,

Paraprofessionals, Principals)

*Annual premiums

based on groups with

highest District

contribution.

^The HSA premiums

will vary based on

individual

contribution to the

HSA account (the

higher contribution

the higher health

premium)

Maggie is a single, healthy female who takes advantage of

preventive care visits. In a typical year, she usually sees the

doctor twice. She has a preferred brand prescription for

Singulair that costs $120 (retail) and is filled twice per year.

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200-25

Plan

2600/5200 HSA Plan

($115 District

Contribution to HSA,

assumes $0 by employee)

*Annual premiums $5,590 $0^

Office visits $375 $1,650

Rx drugs $288 $1,500

Total estimated

maximum costs $6,253 $3,150

Reimbursable

expenses in HSAn/a

$3,150

($3,150 is reimbursable,

but $115 annual trust

amount)

Cost after HSA

reimbursement$6,253 $3,035 ($3,150-$115)

HSA Balance n/a $0

*Annual premiums

based on groups

with highest

District

contribution.

^The HSA

premiums will vary

based on

individual

contribution to

the HSA account

(the higher

contribution the

higher health

premium)

Carol’s family includes two children under the age of 6 and her

husband. During the year there are a total of 15 visits to the

doctor and 2 prescriptions per month between all the family

members. The prescriptions filled included 12 preferred

generic and 12 preferred brand ($1,500 total retail cost).

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Recordkeeping Whenever you use HSA funds to pay for a medical

expense, you should keep your receipt

You are responsible for demonstrating to the IRS that HSA

distributions were for qualified medical expenses

If the IRS requests receipts for verification purposes,

failure to provide those receipts could result in having to

pay a penalty

IRS Forms sent by Further IRS Form 1099-SA

Provides the total amount distributed from your HSA in prior

year. This form will be mailed to you by January 31, and

reported to the IRS by February 28.

Do not attach Form 1099-SA to your income tax return.

Instead, keep it for your records.

IRS Form 5498-SA

Provides the total amount of contributions credited to your

HSA for prior year. Rollover amounts and year-end fair

market values also are reported on this form. This form will

be mailed to you after April 15, to allow you time to apply

additional contributions to your HSA for prior year. It will be

mailed by May 31, and a copy will be sent to the IRS on your

behalf.

Do not attach Form 5498-SA to your income tax return.

Instead, keep it for your records.

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IRS Forms sent by Further

IRS Form 1099-SA

– Provides the total amount distributed from your HSA

in prior year. This form will be mailed to you by

January 31, and reported to the IRS by February 28.

– Do not attach Form 1099-SA to your income tax

return. Instead, keep it for your records.

IRS Form 5498-SA

◦ Provides the total amount of contributions credited to

your HSA for prior year. Rollover amounts and year-

end fair market values also are reported on this form.

This form will be mailed to you after April 15, to allow

you time to apply additional contributions to your HSA

for prior year. It will be mailed by May 31, and a copy

will be sent to the IRS on your behalf.

◦ Do not attach Form 5498-SA to your income tax

return. Instead, keep it for your records.

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