HSA-HDHP Scenarios

 The following examples for an individual and a family show how the HSA-HDHP covers certain costs — both expected and unexpected — in the course of a year.

Example: Maria, individual coverage

• Maria is 25 years old and single.
• Wells Fargo funded $350 into her HSA on January 1.
• Maria contributes $38.46 per pay period — or $1,000 a year — into her HSA.
• She has a total annual contribution of $1,350 to her HSA.
• The plan has a deductible of $2,000 with an out-of-pocket maximum of $4,000 (includes the deductible).

Maria is very healthy for much of the year. She has one regular physical at a cost of $250, which is fully covered by the HSA-HDHP and is not applied to her deductible.

Maria also takes one medication that is considered preventive at a cost of $50 per month. She pays 20% of the total cost of the medication without meeting her deductible, and can use her HSA to pay for her portion of the preventive prescription.

In September, Maria breaks her leg and has in-network health care expenses of $856, with pain medications that cost $62.

Example of Maria's Medical Expenses for 2009

Maria’s Medical Services	Total Medical Expenses	Medical Expenses Applied to Deductible and Paid by Maria	Coinsurance Paid by Maria	Medical Expenses Paid by Health Plan
In-network expenses, preventive care	$250	$0	$0	$250
Preventive medication, $50 per month — Maria pays 20%, plan pays 80%	$600	$0	$120	$480
Broken leg — $856 health care expenses, $62 pain medications	$918	$918	$0	$0; still under deductible amount
Total	$1,768	$918	$120	$730

Maria chooses to use her HSA to pay for her $918 out-of-pocket expenses, along with the $120 for her preventive medication, leaving her with $312 in her HSA at the end of 2009 which rolls over to 2010.

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Example: Jay, family coverage

• Jay is married with coverage for his wife Tonya and their daughter.
• Wells Fargo funded $750 into his HSA on January 1.
• Jay contributes $76.92 per pay period — or $2,000 a year — into his HSA.
• He has a total annual HSA contribution of $2,750.
• The plan has a family deductible of $4,000, with a family out-of-pocket maximum of $8,000.

Jay controls a condition with medication that is considered preventive at a cost of $80 per month. He visits his doctor every six months to monitor his medication at a total of $180. These visits are not considered preventive.

He, his wife, and daughter also have a physical once a year at a total of $600.

In November, Tonya has a ski accident that results in $10,000 in medical bills. She requires additional physical therapy for two months at a total of $800.

Example of Jay's Family Medical Expenses for 2009

Jay and Family’s Medical Services	Total Family Medical Expenses	Medical Expenses Applied to Deductible and Paid by Jay	Coinsurance Paid by Jay	Medical Expenses Paid by Health Plan
In-network health care expenses, preventive care — three physicals	$600	$0	$0	$600
Preventive medication, antidepressant — $80 per month	$960	$0	$192	$768
Jay's two doctor visits for medication management — January and June	$180	$180	$0	$0
Tonya’s total accident expenses — $10,000 medical bills, $800 physical therapy	$10,800	$3,820	$1,396	$5,584
Total	$12,540	$4,000	$1,588	$6,952

Jay is responsible for $5,588 in medical expenses in 2009. He only has $2,750 in his HSA for the year; leaving him with $2,838 in additional out-of-pocket charges. As a result, he has no amount available in his HSA at the end of 2009.

Note: For Domestic Partner coverage, certain tax laws apply to HSA contributions. Consult your tax advisor.

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