1. 1 qualified HDHP IRS HSA limits for 2015 HIGH DEDUCTIBLE HEALTH PLAN LIMITS Notes – required for HSANew 2015 IRS Limits2014 Minimum Individual Deductible applies to Individual and Aggregate deductibles, In Network or Combined $1,300$1,250 Minimum Family Deductible applies to Embedded Deductible Plan, In Network or Combined - for an individual on family coverage plan, individual can receive benefits for covered services once individual deductible is met $2,600$2,500 Maximum Individual Out of Pocket In Network or Combined – medical and pharmacy co-payments and deductibles apply to out-of-pocket $6,450$6,350 Maximum Family Out of Pocket In Network or Combined – medical and pharmacy co-payments and deductibles apply to out-of-pocket $12,900$12,700 Maximum Individual Contribution to a HSA An allowed dollar amount for an individual to deposit within a calendar year $3,350$3,300 Maximum Family Contribution to a HSA An allowed family dollar amount for employee to deposit within a calendar year $6,650$6,550

2. 2 qualifications for an HSA To be eligible to open an HSA, the member (employee) must meet the following requirements: 1.Be covered under a high deductible health plan (HDHP) on the first day of any month for which eligibility is claimed 2.The HDHP can include the Rx in the plan or separate (rider) as long as the minimum deductible of the HDHP is met prior to pharmacy benefits being utilized 3.Not be enrolled in Medicare. 4.Not be claimed as a dependent on someone else’s tax return. 5.Have no other insurance except what’s permitted by the IRS (see IRS Publication 969).

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