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High Deductible Health Plan (HDHP) with Health Savings Account (HSA)

Frequently Asked Questions

There are two components to the High Deductible Health Plan (HDHP) with HSA. Medical Plan ­ the HDHP Health Savings Account (HSA)

MEDICAL PLAN ­ HDHP

Eligibility

Q1: Who is eligible to participate in a HDHP with a HSA? Professional-administrative, management and executive active employees and Retiree Choice Retirees residing in the U.S. and on U.S. payroll are eligible for a HDHP with HSA. The following requirements are based on IRS Guidelines. Employees and Retirees (the HSA account holder) must: Not be enrolled in Medicare. However, dependents may be enrolled in Medicare. Not be covered under any other health plan that is not an HDHP. However, dependents enrolled in the HDHP with HSA may have other non-HDHP coverage. Not be claimed as a dependent on someone else's tax return. Additionally, the company does not allow an account holder to switch HDHPs within the same contract year.

Plan Coverage

Q2: What medical services are covered at 100%, not subject to my deductible and co-insurance? Preventive care services that meet the Preventive Service Guidelines are covered at 100%. Covered preventive services are based on national medical association preventive care and Chrysler benefit guidelines. See Preventive Service Guidelines located on Dashboard / Health Plans. Q3: What medical services are subject to my deductible and co-insurance? All covered hospital, surgical, medical services including foot care, mental health and substance abuse services, prescription drugs and durable medical equipment are subject to deductible and co-insurance up to the out-of-pocket maximum. Federal law requires health plans coupled with a HSA must have a high dollar deductible.

Preventive Care

Q4: Is preventive care covered? A key feature of HDHP with HSA plans is the focus on prevention. Recommended preventive care services per Chrysler guidelines are covered by the HDHP with HSA in full (paid at 100%) for in-network providers. This benefit is not subject to the deductible. Preventive services received out-of-network are covered subject to the out-of-network plan design. Age and frequency limitations apply. See Preventive Service Guidelines located on Dashboard / Health Plans for a listing of covered services. 1

Q5: How is diagnostic care covered? Diagnostic services performed to investigate existing symptoms or monitor ongoing conditions are subject to your deductible and co-insurance up to your out-of-pocket maximum. Q6: What is the difference between preventive care and diagnostic care? Preventive care includes routine screenings to promote disease prevention and early detection. Preventive care does not include maintenance for diagnosed medical conditions or services performed to diagnose a probable medical condition when symptoms already exist. Diagnostic tests are performed to investigate existing symptoms or monitor ongoing conditions. If a medical condition is diagnosed or considered probable during a preventive exam, any supplemental tests/medical services will be coded as diagnostic. Q7: How will I know if my preventive screening will be paid at 100%? Review the recommended Preventive Service Guidelines for age and frequency limitations to identify the services you are eligible to receive. Advise your health care provider that preventive care is paid at 100% and should be coded as preventive when care meets the Preventive Services age and frequency restrictions and preventive care definition. Q8: What if my preventive service is billed with a diagnostic and a preventive code? A covered preventive service that is billed with multiple diagnoses which includes both a covered preventive and diagnostic billing code will be paid at 100% as preventive care. If you are billed for a covered preventive service with multiple diagnoses, you may need to contact your health plan to request your preventive claim be processed as preventive. Q9: Are the preventive frequency limitations allowable by calendar year or by the exact date of service? For example, if I have my annual physical on August 1st, do I need to wait until August 1st of the following year to have another annual physical. Preventive services are allowable by calendar year and not limited by exact dates of service. They are reset every year on January 1. Therefore, you do not have to wait until the exact date the following year to have another annual physical.

Network Providers

Q10: Is my doctor in the network? To find a provider, search this network: Blue Cross Blue Shield HSA Member: www.bcbsm.com 800-521-0488 Non-members: www.bcbsm.com/ChryslerCDH 800-521-0488 Q11: When should I pay my network provider for medical services? Always show your health plan member ID card when receiving care or purchasing prescriptions to ensure that you get the in-network discount. For doctor's office visits or facility charges, have your provider submit the claim to the health plan to ensure you get all network discounts you are entitled to and to determine the appropriate member responsibility before you pay the expense. When you receive

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the bill from your medical provider, you can use your HSA debit card or pay out of your own pocket and save your HSA funds.

HEALTH SAVINGS ACCOUNT ­ (HSA)

Q12: What is a Health Savings Account (HSA)*? A HSA is an investment account to save money to pay for qualified medical expenses with tax-free dollars. You can use funds in this account now or save them for later. The HSA provides significant tax advantages ­ your contributions aren't taxed going into your HSA, interest earned isn't taxed and your money isn't taxed when withdrawn as long as it is used to pay for qualified medical expenses. That means you can acquire a nest egg of completely tax-free savings to pay for a wide range of qualified health care expenses, as defined by the IRS. *All HSA tax references and certain eligibility requirements are regulated by the IRS. Consult a tax advisor.

Eligibility

Q13: Who qualifies to receive distributions for qualified medical expenses from my HSA? You and your spouse and all dependents claimed on your tax return are eligible to use the money in your HSA. Q14: Am I eligible to use the money in my HSA account if I am no longer enrolled in a HDHP? Yes, if you switch plans and have money in your HSA, the account is still yours to use for any current or future qualified medical expense incurred by the account holder, your spouse, and qualifying dependents. However, no future contributions to your HSA are allowed while you are not enrolled in a HDHP and you will be responsible for any maintenance fees on the account. Q15: Am I eligible to participate in a Flexible Spending Account (FSA) while I am enrolled in a HDHP with HSA? Yes. However, per IRS regulations, you cannot use your FSA funds to pay your health plan deductible. You may only submit expenses that are in excess of your annual deductible for reimbursement through your FSA. Q16: Can I still participate in the Retirement Health Care Account (RHCA) through my 401(k) account along with my HSA? Yes. You can still save for health expenses expected in retirement with your Retirement Health Care Account offered through your 401(k) account. Your HSA is supplemental to your RHCA. The difference with your HSA is that you can choose to use your savings now or save for expenses later in life. Q17: What happens to the money in my HSA if I die? If you are married, your spouse becomes the owner of the account. As owner of the account, your spouse can use the HSA to pay for qualified medical expenses with the same tax advantages. However, if your spouse uses the HSA funds for any other reason, the funds will be federally taxed. If you are not married, the account will pass to your beneficiary or become part of your estate and subject to applicable taxes. Q18: Are HSAs portable?

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Yes, a HSA is an individual investment account that belongs to you. You can take your HSA balance with you if you leave the company or retire. You may be subject to administrative fees if you maintain money in your HSA account but are not enrolled in the corresponding HDHP.

Contributions

Q19: Can I change my HSA contribution amount during the year? Yes, you can start, stop or change the amount you are contributing to your HSA during the year by calling Benefit Express or making a lump sum contribution directly to the HSA Administrator. You have two options to increase the employee contribution amount: 1. Contact Benefit Express at 1-888-456-7800 (Actives) to change your pre-tax contribution rate through payroll deduction. 2. For lump sum contributions directly to your HSA that are not payroll deducted, complete a Deposit/Contribution slip from your HSA Administrator and forward with your personal check or transfer funds directly your bank account. You can make contributions up to April 15th for the previous tax year. Forms are available from Dashboard Anywhere / Health Plans or from your HSA website. You will need to keep record of the amount you contributed for year-end tax purposes. HSA administrator contact information: Health Plan HSA administrator HSA online HSA customer service BCBS Healthy Blue Choices HSA Bancorp Bank www.bcbsm.com 800-521-0488 Q20: Can I make a lump sum employee contribution through payroll deduction? Yes, you can choose to make a lump sum payroll contribution or have the amount deducted in equal amounts from each paycheck throughout the year. Lump sum payroll contributions must be elected during open enrollment and will occur on the first payroll deduction. Lump sum contributions can also be submitted directly to your HSA administrator and claimed on your tax forms. Contact Benefit Express to make changes to payroll deductions at 888-456-7800. Q21: How are employer contributions made? The lump sum employer contribution is made at the beginning of the plan year and will be available by the end of January. Once available, employer contributions belong to you. Employer contributions are made directly to the HSA Administrator and recorded on your pay statement for proper tax reporting. Q22: What are the tax advantages of an HSA? The HSA provides significant tax advantages ­ the company contribution and your payroll deducted contributions are not taxed going into your HSA, interest earned isn't taxed and your money isn't taxed when withdrawn as long as it is used to pay for qualified medical expenses. Your contributions reduce the amount of current taxes you pay. Q23: Is there a minimum amount I must contribute to my HSA each year? You can choose whether to contribute and how much you want to contribute to your HSA, but the total cannot exceed the maximum contribution amount in the table above. There is a payroll minimum set forth.

Accessing the money in your HSA Account

Q24: When will the funds be available to use? 4

The lump sum company contribution amount will be available in your HSA account in mid-January of the plan year. Your payroll deducted contribution is sent to your HSA Administrator monthly based on your payroll cycle. If you incur medical expenses early in the year before your funds are deposited, you can submit a reimbursement form later in the year once you have accumulated sufficient funds. Q25: How do I withdraw money from my HSA? You can use your HSA debit card to pay for qualified medical expenses or submit a reimbursement request form to your HSA Administrator. Retain your receipts for documentation if audited by the IRS. Q26: What types of expenses can be paid from a HSA? Qualified medical expenses for both the HSA and FSA are defined by the IRS Publication 502, Medical and Dental Expenses, and are available online at www.irs.gov/pub/irs-pdf/p502.pdf. HSA plan supplement information is available online at http://www.irs.gov/pub/irs-pdf/p969.pdf. In addition to the qualified expenses under the FSA, the HSA allows reimbursement for: Medical expenses used to meet your HDHP deductible. Qualified long-term care insurance premiums. Other qualified medical insurance premiums (not including Medicare policies) Q27: How will I know how much is in my HSA? You can monitor your HSA funds online to view fund balance, claim status and eligibility information. You can review quarterly statements for detailed information about your fund balance and claims activity for the quarter. Also, you can always call the customer service number on your health plan card. Q28: Can I use the money in my HSA for anything other than eligible medical expenses? You can withdraw the money from your HSA at any time and use it for any purpose. However, if the money is used for anything other than qualified health care expenses, you will pay income taxes on the amount withdrawn as well as a 10% penalty. Q29: What happens to the money in my HSA if it isn't spent by the end of the year? Any money left in your HSA at the end of the year accumulates from one year to the next to be used for future medical expenses. If you use the money for anything other than qualified health care expenses, it will be treated as taxable income, and is subject to an IRS imposed penalty. Q30: If I have a medical expense that is eligible for payment from my HSA, am I required to use the money? No. You have flexibility to choose how you use the money you've accumulated in your HSA. You could choose to pay the expense out of pocket with taxable dollars and leave the money in your HSA to grow tax free for use in the future. Q31: What if I have a medical expense that is greater than the amount of money in my HSA? If you have an expense that is greater than the balance in your HSA, only the balance in your HSA will be paid. For example, if you submit a $500 claim for reimbursement but only have $200 in your HSA, only $200 can be paid. To receive the additional $300, you would need to resubmit a new request later when more funds have been deposited into your HSA. The money does not have to be in your Health Savings Account at the time the expense was incurred as long as you were enrolled in the Health Savings Account at the time the expense was incurred. 5

When using your HSA debit card, it is important to know how much is in your HSA since the transaction will be denied if more than the balance available is requested. Investment Options Q32: What investment options will I have for the money in my HSA? You will have several investment options for the dollars in your HSA. The range of options is determined by the HSA administrator. Bancorp Bank and JPMorgan Chase require a minimum balance of $2,000 before investment options become available. HSA Enrollment Q33: What is the enrollment process for an HSA? You enroll in the HDHP with HSA plan and choose how much you want to contribute via payroll deduction. You will receive two cards ­ a medical card from the medical plan and a debit card (once you open your HSA) along with forms from the HSA administrator. You complete the required forms and return them to the HSA administrator. You are required to activate the account on-line before the debit cards are issued and funds are deposited. To receive tax-favored treatment for distributions from your HSA, any qualified medical expenses must be incurred after the date that your HSA is established and funded. If you do not open your HSA account you will forfeit the employer contribution. Q34: Is there a cost to establish an HSA? There is a monthly administrative fee that is paid for by Chrysler while you are enrolled in an HDHP. You may be required to pay a monthly administrative `investment' fee that will automatically be deducted from your HSA Cash account. If you terminate HDHP coverage or change to another HDHP and maintain a balance in your HSA, you will be responsible for all fees associated with the HSA from the time the account is ported to an individual account. You are also responsible for any banking fees associated with the HSA. Check with each trustee for a listing of current banking fees. Tax Records Q35: What tax forms will I receive? You will receive a W-2 from Chrysler which shows in box 12(w) the total company contributions and personal contributions that were payroll deducted. Your HSA Administrator will send you the following forms at the end of the year: 1099-SA - showing total annual distributions from your HSA. 5498-SA ­ showing total annual contributions and total account value of your HSA. Q36: What type of records do I need to keep? You are responsible for keeping records of eligible expenses. Use Form 8889 to report all contributions to your HSA. If your tax return should get audited, you might be asked to provide receipts for the expenses that were reimbursed. You can use your Explanation of Benefits (EOBs) and other receipts to validate qualified medical expenses. Your HSA is regulated by the IRS, not Chrysler.

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