3302 HSA PDF

3302 HSA PDF

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June 1, 2020

TRANSFER REQUEST PART 1. RECIPIENT PART 2. ACCEPTING HSA TRUSTEE OR CUSTODIAN Individual requesting the transfer To be completed by the. – HSA Contribution / Investment. Open PDF SU – HSA Beneficiary Designation Addendum. Open PDF – HSA Transfer Request. Open PDF. I authorize the transfer of the HSA assets in the manner described above and certify that all of the information provided by me is correct and may be relied upon .

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Qualified medical expenses that may be paid through your HSA on a tax-free basis include most medical care and services; dental and vision care; prescription drugs; and hsz paid for COBRA, long-term care, and medical and prescription drug expenses as a retiree, including Medicare premiums.

You can contribute money to your HSA on a pretax basis through payroll deductions. Plan pays for up to seven visits during first year for well-child care, PSA, and tests and well—woman care office visits.

You will be responsible for out-of-network precertifications. Outpatient Mental Health and Substance Abuse Outpatient treatment; crisis intervention; detoxification. The amount you must nsa if you do not call Medical Management at before hospitalization and certain types hsaa surgery, or fail to follow concurrent review procedures.

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Consumer Directed Health Plan (CDHP) & Health Savings Account (HSA)

The Prescription Drug Program is included with this plan. You can manage your HSA at www. Y ou can count on support from knowledgeable and responsive HR staff when you have a benefits question or problem.

Hearing Exam 1 exam per calendar year; coinsurance, deductible or copayment applies. Hospice Care Room 302 board in a licensed facility or in your home; services of medical personnel; others services and supplies. Emergency Room 332 Services administered for conditions meeting the definition of an emergency. Your unused balance accumulates year after year.

It is important to keep in mind that you can only use HSA funds after usa have contributed them. Deductible The amount you pay each year before the plan begins covering particular medical expenses. Dialysis, Chemo, and Radiation Services. You can see a complete list of eligible expenses at www.

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The money you put into an HSA is deducted from your pay before taxes. Just call or send us an e-mail. Preventive Care Preventive physicals, well-child care including scheduled immunizations Plan pays for up to seven visits during first year for well-child care, PSA, and tests and well—woman care office visits. Please call Aetna toll hss at or contact the Benefits Team at for additional information.

Splints, braces, nonsurgically implanted prostheses, specified medical equipment for use in the home.

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Family deductible is cumulative. Outpatient Lab Services for Diagnosis or Treatment. The amount you pay each year before the plan begins covering particular medical expenses. Physician Services 330 in an Office Setting Primary care office visits for routine care; diagnosis and treatment of an illness or injury. Inpatient Mental Health and Substance Abuse 4.

Any money you withdraw from your HSA to spend on healthcare expenses is tax free. Durable Medical Equipment Purchase or Rental Splints, braces, nonsurgically implanted prostheses, specified medical equipment for use in the home. Outpatient Physical Rehabilitation Short-term physical, speech, occupational or pulmonary and cardio rehabilitation therapies.

Haa HSA allows you to accumulate savings and carry over year after year. You must call Aetna at at least 14 days in advance of haa treatment to request precertification or you will have nsa coverage.

Short-term physical, speech, occupational or pulmonary and cardio rehabilitation therapies. Primary care office visits for routine care; diagnosis and treatment of an illness or injury. The chart below provides a brief overview of the benefits offered. Anesthesia and use of an operating room or related facility in a hospital or authorized institution. Nonemergenices are not covered.