Health Savings Account

Health Savings Account (HSA)

Administered by Optum Bank

Eligibility

To contribute to a Health Savings Account (HSA) you must be enrolled in the Medical HSA plan.

General Information

An HSA is a tax-advantaged personal savings account that can be used to pay for medical, dental, vision and other qualified expenses now or later in life. The funds can even be invested once your account balance reaches a certain threshold, making it a great addition to your retirement portfolio.

How the HSA Works

Funds can be contributed to the HSA by either the employer or employee. Hafele America Co. will contribute the following amounts to the HSA depending on the coverage tier:

Single Coverage – $500 per year
Family Coverage – $1,000 per year

Contributions to the HSA are tax-free up to the following IRS limits:

Single – $4,400 per year
Family – $8,750 per year

There is also an annual catch-up contribution of $1,000 allowed for those age 55 and older.

Please note that the annual contribution limits listed above include both employer and employee contributions.

All money used in the HSA to pay for qualified medical expenses is also tax-free. Unused funds remain in your account and rollover year after year with tax-free interest. HSAs are portable, so you take it with you if you leave the company. It’s your money.

Important Caveats:

You cannot enroll in a regular health care FSA and an HSA. If you elect the HSA, you will be able to enroll in a limited purpose FSA, which is only for dental and vision expenses. (Enrollment in a dependent care FSA is still allowed with an HSA.)
Contributions to an HSA must stop once an individual is enrolled in Medicare – funds can still be used for eligible medical expenses, but no further contributions can be made.

HSA Plan Benefits

Col1	Col2	Col3
Benefit Provision	In-Network	Out-of-Network
Deductible (per Calendar Year) • Individual • Family Member • Family	$3,000 $3,400 $6,000	$6,000 $6,800 $12,000
Out-of-Pocket Maximum • Individual • Family Member • Family	(Includes Deductible & Copays) $4,900 $4,900 $9,800	(Includes Deductible & Copays) $9,800 $9,800 $19,600
Coinsurance	You pay 20% after Deductible (unless noted otherwise)	You pay 50% after Deductible (unless noted otherwise)
Office Visits • Preventive Care • PCP • Primary360 (virtual PCP) • Specialist • Virtual Visit (Teladoc) • Mental Health • Chiropractic Care (20 visit per calendar year) • Nutritional Counseling (30 visits per calendar year)	100% Covered 20% after deductible 0% after deductible 20% after deductible 0% after deductible 20% after deductible 20% after deductible 0% after deductible	30% after Deductible 50% after Deductible Not Covered 50% after Deductible Not Covered 50% after Deductible 50% after Deductible 30% after Deductible
Emergency Room Urgent Care	20% after deductible 20% after deductible	20% after deductible 50% after deductible
Prescription Drug (per 30-day supply) • Tier 1 • Tier 2 • Tier 3 • Tier 4 • Tier 5 Mail Order (per 90-day supply) • Tier 1 • Tier 2 • Tier 3 • Tier 4 • Tier 5	Deductible, then $10 Deductible, then $10 Deductible, then $40 Deductible, then $105 Deductible, then $150 Drugs on the Preventive Drug List are covered 100% Deductible, then $30 Deductible, then $30 Deductible, then $120 Deductible, then $315 Deductible, then $450	Deductible, then $10 Deductible, then $10 Deductible, then $40 Deductible, then $105 Deductible, then $150 Not Covered