1. YOUR CIGNA CHOICE FUND® HEALTH SAVINGS ACCOUNT
TAXES
PLAN YEAR: 2015
d Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company

2. HEALTH SAVINGS PLAN AND YOU
Qualified high
deductible
medical plan
Health Savings Account
Tax- advantaged
HSA Plan + =
A tax-advantaged health plan that provides coverage for current health care expenses with the option to save for future health care expenses
Combines a qualified high deductible medical plan (medical/pharmacy coverage) with a Health Savings Account
You, your employer or both can contribute to the Health Savings Account which is owned by you
Money put in the Health Savings Account is generally not taxable*
You have investment options with the Health Savings Account
* HSA contributions and earnings are not subject to Federal taxes and not subject to state taxes in most states. A few states do not allow pretax treatment of contributions or earnings. Please consult your personal tax advisor or contact your plan administrator for information about your state.

3. Refresher on HSA Basics
Health Savings Account (HSA)
What is a Health Savings Account?
Who May Contribute?
An HSA is a tax-advantaged health savings account. The money deposited into the account can be used to pay for qualified medical expenses.
Individual/Employee and Employer
Who Owns Account?
Individual/Employee*
Maximum Contributions (2015)
(Employee & SPU)
Individual - $3,350
Family - $6,650
How is maximum calculated?
Based on CDHP enrollment tier selected
Additional Contributions Allowance
Allowed for persons age 55 and older “catch up” contribution $1,000
Portable?
Yes
Rollover of Funds?
Tax Status of Employee Contributions
Exempt from Federal Taxes and exempt from State taxes in all states except CA, NJ, NH & AL
Special Rules for Marriage
Total contribution to HSA cannot exceed the family maximum if both spouses have an HSA
*JPMC accountholders are charged a monthly maintenance fee of $1.85
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna 3 3

4. YOUR HSA MAXIMUM CONTRIBUTION***
The IRS has set the following limits for 2015:
Under age 55 and not enrolled in Medicare (based on a 12-month period):
Up to $3,350 individual coverage*
Up to $6,650 family coverage*
Age 55 or older:
Maximum contribution increases by $1,000 (considered a “catch-up” contribution)
Up to $4,350 individual coverage*
Up to $7,650 family coverage*
To make the maximum contribution in a calendar year, you must:
Meet all requirements to be eligible for HSA contributions on January 1
Remain qualified through December 1
If these criteria are not met, maximum contribution is prorated = if 1/12 maximum contribution for each month then individual is qualified $
*Contributions to your HSA that you receive from your employer and incentives count toward your maximum.

5. As an HSA accountholder, every year you may receive two forms from JPMorgan Chase Bank
1099-SA
5498-SA

6. Form 1099-SA
The 1099 form Reports calendar year distributions from the Health Savings Account, so this would include any Debit card purchases, ATM withdrawals, Cash advances made at bank branches, HSA checks paid/cashed, and Automatic claim payments
It will be mailed in late January, If there were no distributions during the year, 1099-SA will not be sent
You should keep all receipts and records for these qualified expenses in case the IRS requests to view them

7. Form 1099-SA
Do I have to report information on Form 1099-SA on my federal income tax return?
Yes. You must report distributions (all money spent from HSA) from your HSA on IRS Form 8889.

8. Form 1099-SA
Box 1: reports the total distributions made from your HSADistributions include any purchase or withdrawal using your HSA
Box 2: reports any earnings on excess contributions.

9. Form 5498-SA

10. $
Form 5498-SA
This form is for informational purposes and supports contributions already on your tax return
Box 2: Reports total contributions to your HSA for 2013
Box 3: Reports for contributions made in 2014 for 2013.

11. How To Access JPMorgan Chase on myCigna.com

12. How To Access JPMorgan Chase on myCigna.com
Click here for JPMorgan Chase Website

13. Open to your Chase account page

14. How to Access Forms

15. Form 8889 FEDERAL FORM 8889 Contributions Distributions
Determination of Federal Taxes if:
Non-Qualified Distributions
Excess HSA contributions
Form availability
pdf/f8889.pdf

16. Access your YTD Tax Year Summary link or your Year-End Statement to complete Form 8898

18. Additional Questions?
Additional information is available in IRS Publication 969 on the IRS website.
If you have additional questions about your HSA contributions or distributions, contact HSA Customer Service

19. DISCLAIMER
Cigna HealthCare does not advise on any personal income tax requirements or issues. Use of any information from this presentation is for general information only and does not represent personal tax advice either express or implied. You are encouraged to seek professional tax advice for personal income tax questions and assistance.

20. Product Disclosures
Rates will vary by plan design including the amount of plan deductibles, coinsurance, and out-of-pocket and lifetime maximums. Rates may vary based on age, gender, geographic location and the plan deductible selected.
All insurance policies and general service agreements have restrictions, exclusions, limitations, reductions of benefits and terms under which the policies or agreements may be continued in force or discontinued. Terms and conditions of coverage are set forth in the plan documents - the insurance certificate, plan booklet, policy, contract and/or summary plan description.
“Cigna,” the “Tree of Life” logo, “GO YOU” and “Cigna Choice Fund” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., Cigna Onsite Health, LLC, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In California, HMO and Network plans are offered by Cigna HealthCare of California, Inc. In Connecticut, HMO plans are offered by Cigna HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by Cigna HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. In Texas, Open Access Plus plans are considered Preferred Provider plans with certain managed care features. All models are used for illustrative purposes only.
838559d 07/ © 2013 Cigna. Some content provided under license.