HSA Chapter for Montana

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BENEFITS 2012 ProvSelect HSA

ProvSelect HSA:

ProvSelect HSA Advantages of selecting the ProvSelect HSA Plan No cost to you: There is no cost to you for the ProvSelect HSA plan, even if you cover dependents. Providence health incentives: You can earn up to $1,400 in Providence contributions to your HSA if you complete certain health activities. Tax savings: You do not pay tax on your contributions or Providence’s contributions to your HSA, nor on any investment earnings. You also do not pay tax on the funds you withdraw to cover eligible expenses.

ProvSelect HSA:

ProvSelect HSA Incentives By December 15, 2011 - complete the following activities to be eligible for incentive Biometric health screening Confidential online health assessment Choose a Primary Care Provider If your spouse/ABR is enrolled, he or she must also complete the activities to be eligible for the incentive www.providence-healthforlife.com

ProvSelect HSA:

ProvSelect HSA Two parts Insurance coverage (high deductible PPO) Health Savings Account

ProvSelect HSA :

ProvSelect HSA Insurance Coverage Preventive care covered at 100% Annual Deductible: $1,500 employee only tier, $3,000 all other tiers Out-of-pocket maximum: $2,500 employee only tier, $5,000 all other tiers In Network Office Visits (80% coinsurance after deductible is met) Out of Network (50% coinsurance after deductible is met)

ProvSelect HSA:

ProvSelect HSA Insurance Coverage (continued) Inpatient Care is covered after the deductible is met 100% at a Providence Facility 80% for all other in-network facilities and 50% out-of-network Prescription Drugs Preventive generic and brand formulary drugs are covered at 100% Preventive drugs list is available at: www.providence-healthforlife.com Non-preventive drugs are covered at 80% subject to deductible

ProvSelect HSA:

ProvSelect HSA Health Savings Account Eligibility to open a Health Savings Account Enrolled in a qualified high deductible plan ( ProvSelect HSA qualifies) You cannot be enrolled in another plan (including a Providence plan) as a spouse/adult benefit recipient (ABR) You cannot be enrolled in a state or federal Medicare or Medicaid Plan Contributions to a Health Savings Account Providence contributes through health incentive You can contribute through payroll deductions

ProvSelect HSA:

ProvSelect HSA Health Savings Account – Health Incentive EE Only EE + Child( ren ) EE + Adult EE + Family Employee Health Incentive Deposited in HSA in January if you complete the incentive activities $700 $1,000 $700 $700 Spouse/ABR Health Incentive Deposited in HSA in January if your spouse/ abr complete the incentive acitivies N/A $0 $700 $700 Total Possible HSA Seed $700 $1,000 $1,400 $1,400

ProvSelect HSA:

ProvSelect HSA A savings account for you to save before-tax dollars to pay for qualified health care expenses + $3,100 for an individual $ 6,250 for a family Contribute an additional $1,000 in 2012 if you are age 55 or older Automatic before-tax payroll deductions or by personal check to HealthEquity, the HSA administrator All contributions are deposited to HealthEquity – you have to verify you would like to open an account (and that you are eligible) or your money is forfeited = + 2012 catch-up contributions (if eligible) Total 2012 maximum, combined contributions to HSA Employee contributions (optional) Providence 2012 contributions

ProvSelect HSA:

ProvSelect HSA Health Savings Account Advantages HSA balance rolls over from year to year Health incentive dollars deposited into your account tax free from Providence Utilize HSA to pay for deductibles and coinsurance as well as eligible expenses (the same list as flexible spending accounts) Use as a vehicle for retiree medical savings Your contributions reduce your taxable income The funds you withdraw to pay for qualified medical expenses remain untaxed Your HSA earns interest - tax free and once your account is at $1,000 you can invest in mutual funds

ProvSelect HSA:

100% of in-network preventive care services Including preventive prescription drugs Deductible $1,500 Providence Health Savings Account Contribution Employee Health Savings Account Contribution In-network Coinsurance Providence 80% - 100% Employee 0% - 20% Comprehensive Protection Out-of-pocket maximum $2,500 100% of in-network preventive care services Including preventive prescription drugs Deductible $3,000 Providence Health Savings Account Contribution Employee Health Savings Account Contribution In-network Coinsurance Providence 80% - 100% Employee 0% - 20% Comprehensive Protection Out-of-pocket maximum $5,000 Employee Only Coverage Employee plus family coverage (all tiers) ProvSelect HSA

ProvSelect HSA - Example:

ProvSelect HSA - Example Employee Only Best Case Scenario Worst Case Scenario Preventive Care Deductible Coinsurance Total Out-of-Pocket Expense Providence HSA Contribution $0 $0 $0 $0 $700 $0 $1,500 $1,000 $2,500 $700 $700 Net Savings $1,800 Net Expenses Employee and Family Best Case Scenario Worst Case Scenario Preventive Care Deductible Coinsurance Total Out-of-Pocket Expense Providence HSA Contribution $0 $0 $0 $0 $1,000 - $1,400 $0 $3,000 $2,000 $5,000 $1,000 - $1,400 $1,000 - $1,400 Net Savings $3,600 - $4,000 Net Expenses

ProvSelect HSA - Example:

ProvSelect HSA - Example Employee and Family ProvSelect HSA Best Case Scenario Prov Preferred PPO Best Case Scenario Preventive Care Employee Premium Contribution* Deductible Coinsurance Plan Out-of-Pocket Expense Providence HSA Contribution Employee HSA Contribution* $0 $0 $0 $0 $0 $1,400 $4,356 $0 $4,356 $0 $0 $0 $0 0 $5,756 Net Savings $4,356 Net Expenses *represents family coverage contributions in the ProvPreferred PPO in 2011

ProvSelect HSA - Example:

ProvSelect HSA - Example Employee and Family ProvSelect HSA Worst Case Scenario Prov Preferred PPO Worst Case Scenario Preventive Care Employee Premium Contribution* Deductible Coinsurance Plan Out-of-Pocket Expense Providence HSA Contribution Employee HSA Contribution* $0 $0 $3,000 $2,000 $5,000 $1,400 $4,356 $5,756 $0 $4,356 $750 $3,950 $4,500 $0 $0 $756 Net Savings $8,856 Net Expenses *represents family coverage contributions in the ProvPreferred PPO in 2011

Questions about Benefits? :

Questions about Benefits? HR Service Center is here to Assist Email: WAMTREGHRSC@providence.org Phone: 1-888-687-3753, select option 2 Hours: Monday – Friday 6:30 a.m. – 5:00 p.m. (Pacific Time)

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