HSA Seminar PreferredOne HSA Plan 2013 ®

What is an HSA Health Plan? High Deductible Health Plan + Health Savings Account 2 Health Savings Accounts (HSAs) are used in conjunction with a qualified High Deductible Health Plan (HDHP)  Use pre-tax dollars from your HSA to pay the deductible and coinsurance.  First dollar coverage for preventive care

High Deductible Health Plan 3 SM Deductible Individual $1,2500 Family $3,00 Coinsurance Tier 1: 100% Tier 2: 80% 100% Plan paid for covered services Out-of-Pocket Individual $3,500 Family $8,000 Preventive care - 100% Coinsurance Tier 1: 100% Tier 2: 80% & Prescription Drug Copayments Deductible Individual $1,250 Family $3,000 Coinsurance: The percentage of the total cost you must pay for a given service after you have met your plan’s deductible. Copay: A predetermined dollar amount that you must pay for certain services and products. Out-of-Pocket Maximum: The maximum amount you pay out of your pocket for covered services, including the deductible and coinsurance. 100% Plan Paid: Once you reach your out-of- pocket maximum, the plan pays 100% of covered services for the remainder of the plan year. Deductible: The amount you must pay out of your pocket in a plan year before receiving any coverage by the plan.

4 In-Network HSA Plan Benefits  Deductible - $1,250 single/$3,000 family  Coinsurance  North Tier 1 Providers – 100% coverage after you reach the deductible amount is met.  Tier 2 Providers – 80% coverage after you reach the deductible amount is met.  Prescription Drugs North Memorial Pharmacy Generic: $15 copayment after deductible amount is met. Formulary $30 copayment after deductible amount is met. Non-formulary 50% after deductible amount is met, $30 minimum, $200 maximum.  Out-of-Pocket Maximum - $3,500 single/$8,000 family

Health Savings Account 5 SM Deductible Individual $1,2500 Family $3,00 Coinsurance Tier 1: 100% Tier 2: 80% 100% Plan paid for covered services Preventive care - 100% Use your pre-tax HSA dollars to pay for health care charges applied to your deductible and coinsurance. $?$$?$ Out-of-Pocket Individual $3,500 Family $8,000 Deductible Individual $1,250 Family $3,000 Coinsurance Tier 1: 100% Tier 2: 80% & Prescription Drug Copayments

6 Twin Cities Metro Area Outside the Metro Area Customer Service Hours: 7:00 a.m. – 7:00 p.m., CST PreferredOne.com/NM