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					Health Savings Account (HSA) – Plan Details



Health Savings Account (HSA)
A Health Savings Account, or HSA, is not part of your medical plan. It’s a separate, optional, tax-
advantaged savings vehicle available only to individuals covered under high-deductible health plans, such
as the Aetna High-Deductible Health Plan. If you enroll in this plan and contribute to an HSA, you can
use that money to pay your deductible and other qualified expenses. Or, you can let your account keep
growing and use it in the future!

If you enroll in the Aetna High-Deductible Health Plan, you can also sign up for the UMB Health Savings
Account or “HSA” for short. This HSA account is specially designed to work with the Aetna High-
Deductible Health Plan.

The HSA is optional. However, when most people find they’re going to pay a deductible anyway, they’d
rather pay it with tax-free dollars. An HSA lets them do just that. Plus, an HSA lets you keep any unused
HSA dollars. You own the account, and it’s portable. Remember, HSA contributions and any earnings are
tax-free as long as they’re used to pay eligible health expenses, now or in the future.

Eligibility
To be eligible for an HSA, you must meet the following criteria:
• Be covered by a qualified high-deductible health plan (HDHP), such as the Aetna High-Deductible
    Health Plan;
• Not be covered by any other health plan, such as a spouse’s health care plan, though coverage under a
    Limited Use FSA plan is permitted;
• Not be enrolled in Medicare benefits; and
• Not be claimed as a dependent on another person’s tax return.

Enrolling
As a new employee or an employee who changes to benefit-eligible status, you have 31 days from your
start date to enroll in the Health Savings Account. Coverage begins on your start date or the date of your
benefit-eligible status, if you enroll within this 31-day period.

Rehired Employees
If you are an eligible rehired employee, and want to participate in the Health Savings Account, you must
re-enroll. If you are rehired within 30 days of your termination date, your benefit elections in effect on the
date of your termination will be automatically reinstated.

Annual Enrollment
During annual enrollment, held each fall, you can make changes to your benefit elections. The changes
take effect the next January 1. If you have not enrolled in the HSA, you can do so during the annual
enrollment period. Elections made during annual enrollment remain in effect throughout the year. To
continue participating, you must re-enroll each year. Your previous year’s election does not automatically
carry forward.

Communication Materials
•   You will receive a Welcome Letter from UMB containing your account number and contact
    information.
•   You will also receive a YSA card with HSA frequently asked questions (FAQs) and card usage tips.
•   You will receive a monthly account statement detailing your account activity.


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Health Savings Account (HSA) – Plan Details


•   At the end of each calendar year, you will receive both a 1099SA (for distributions) and 4598SA (for
    contributions) for tax purposes.

Making Your Contributions
For 2012, you may contribute up to $3,100 to the HSA, if you elect employee-only coverage, or $6,250 if
you elect any other coverage level. If you are age 55 or older, in 2012 you can contribute up to an
additional $1,000 in catch-up contributions. The limit on catch-up contributions may continue to increase
on an annual basis over the next few years.

HSA contributions and interest are tax-free if used to pay qualified medical expenses.

Your HSA contributions will be automatically deducted from your paycheck pretax and deposited in your
HSA account. You can also make after-tax HSA deposits on your own, but you are limited to the annual
maximum on your total contributions.

HSA contributions will be available for withdrawal when funds are deposited. You can use Your
Spending AccountTM card (YSA card) or automated clearing house (ACH) direct deposit to access your
account funds. Once you reach age 65 and are enrolled in Medicare Parts A or B, your HSA account will
remain open for withdrawals, but you cannot make additional contributions.

Use the HSA to Pay Qualified Expenses, or Save It —
It’s Your Choice
To get the tax-advantages of your HSA, use it only to pay qualified health care expenses for you, your
spouse, or your dependent(s), as defined by the IRS. HSA-qualified expenses generally include all the
same expenses eligible under the Bank’s Health Care Spending Account — deductibles, coinsurance,
prescription drugs, dental and vision care — plus more.

For a full list of eligible expenses, go to IRS Publication 502: Medical and Dental Expenses. Generally, to
be an expense for medical care, the expense has to be primarily for the prevention or alleviation of a
physical or mental defect or illness.

Your HSA Account
Contributions to your HSA are made automatically via payroll deductions. Note: Your HSA does not
actually become active until your HSA Base Account receives a deposit.

You can also choose to make additional contributions to your account, outside of payroll. To make
deposits using a personal check directly to UMB Bank, use the deposit forms found on the UMB website.

If you participated in an HSA in 2010: You will receive fee and account transfer information in your
home mail in late November 2010. You can then decide whether to transfer your existing JPMorgan
Chase Account to UMB Bank, or leave your 2010 Health Savings Account with JPMorgan Chase Bank.

If you enroll in a 2011 Health Savings Account: A new account will be opened with UMB Bank, and
2011 contributions will be deposited into your UMB account.

To access your HSA, go:
    1. Log in to myBenefits – go to http://hrconnect.bmogc.com from any computer with Internet access
       and select myBenefits (U.S.)
    2. Log in
    3. Click on myBenefits from the ESS menu

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Health Savings Account (HSA) – Plan Details


    4. Click on Health Savings Account under Group Enrolled Benefits

Two Tax-Smart Accounts for Health Care Expenses
Use either or both—it’s your choice.
                                   Bank Health Care Spending                    UMB Health Savings
                                   Account                                      Account (HSA)
                                     Also known as Flexible Spending            Available only if enrolled in the High-
                                     Account (FSA)                              Deductible Health Plan
Is it a savings vehicle?             No                                         Yes
Who is eligible?                     All employees                              Employees enrolled in Aetna High-
                                                                                Deductible Health Plan
How much can you                     $5,000 regardless of coverage level        $3,050 if employee-only coverage;
contribute in 2011?                                                             $6,150 if family coverage
Does account earn interest?          No                                         Yes, tax-free
Can you roll it over?                No, unused contributions at year-end       Yes, year after year
                                     are forfeited
Is account portable if you           No                                         Yes
leave the bank?
What can you use it for?             Bank Health Care Spending Account          Anything. However, the Aetna HSA
                                     can be used only for qualified health      is tax-free only if used for qualified
                                     expenses such as:                          health expenses such as:
                                     •   Health plan deductible*                •     All FSA-eligible expenses,
                                     •   Copays and coinsurance                       PLUS
                                     •   Prescription drugs                     •     COBRA premiums
                                     •   Dental care, braces                    •     Medicare insurance premiums
                                     •   LASIK surgery                                once you reach age 65
                                     •   Eyeglasses and contact lenses          •     Premiums under an employer-
                                     •   Amounts not covered by any                   sponsored retiree medical
                                         health plan                                  program once you reach age 65
                                                                                •     Long-term care and long-term
                                                                                      care insurance premiums
                                     *
                                      If you are enrolled in both a bank Health Care Spending Account and
                                     the UMB HSA:
                                     •   Your Bank Spending Account will be considered a “Limited Health
                                         Care Flexible Spending Account” and subject to additional limitations,
                                         and
                                     •   Your health plan deductible under the High-Deductible Health Plan will
                                         be considered an eligible expense for your UBC HSA but not for your
                                         bank Spending Account.
                                     For the official list, see IRS Publication 502 at http://www.irs.gov/.


Distribution Options
You can withdraw funds from your the HSA Base Account using two primary methods: the YSA card
and direct deposit.

YSA Card
YSA offers a signature-based debit card for use at medical, dental, and vision providers, to pay for
qualified medical expenses.
• With the YSA card, you have an easy way to pay for eligible health care expenses.
• It’s easy to use: sign your card and hand it to the cashier or swipe it when making a purchase.
    (Choose “Credit” and provide your signature, if prompted.) The cost is then deducted directly from
    your Health Savings Account. You no longer have to pay out of pocket or wait to be reimbursed for
    your expenses. Instead, you simply pull out your card, pay — and go.


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Health Savings Account (HSA) – Plan Details


•   Before using your YSA card, make sure your account balance has the funds necessary to cover your
    transaction. You can obtain your account balance at any time on the YSA website.
•   The YSA card is also capable of housing a separate balance for a Limited Use Flexible Spending
    Account (FSA) plan. This “stacked” feature allows the Limited Use FSA balance to pay first for any
    dental and vision expenses. Once the Limited Use FSA balance is depleted, the HSA will then
    automatically pay dental and vision expenses.
•   The available balance on the YSA card is equal to the funds deposited in your HSA Base Account.
•   You do not need to show proof for HSA transactions, though it is recommended you save all receipts
    for tax purposes.
•   For the Limited Use FSA balance, you may be asked to show proof of the expenses. It is also
    recommended you save all receipts for tax purposes.

Also see YSA Card Frequently Asked Questions.

Automated Clearing House (ACH) Direct Deposit
•   As an alternative to the YSA card, UMB also offers direct deposit. This works as the name suggests,
    you can make deposit from your HSA Base Account directly into a personal checking, savings or
    money market account.
•   This transaction is performed on the UMB website. You can simply enter the desired amount along
    with the appropriate account and routing numbers, and the funds will transfer automatically.
•   No fee is associated with this transaction.

IMPORTANT INFORMATION:
• There is no ATM access with this plan.
• You are solely responsible for keeping receipts and records of reimbursements for tax purposes.
• You are also responsible for withdrawing funds for qualified expenses and maintaining receipts per
  the IRS guidelines, or you will be subject to income taxes and a 20% penalty.

Your HSA Is Portable – It’s Yours to Keep
Unlike the Health Care Spending Account, HSAs do not have a “use-it-or-lose it” rule. At year-end, any
money left in your HSA rolls over to the next year. Your HSA is yours to keep, even if you change plans
or jobs — or even retire. HSA funds are non-forfeitable.

Portability is one reason many people view the HSA as a long-term savings vehicle. Rather than use up
each year’s HSA contributions on current expenses, you can pay those expenses with other money
(including your bank Health Care Spending Account, subject to certain restrictions) and let your HSA
keep growing for the future.

As with the bank’s Health Care Spending Account, if your life partner and/or life partner’s children
qualify as your tax dependents, their expenses are eligible under an HSA.

Fees
There is a standard fee for any initial investment, as well as a reduced fee for recurring transactions. See
the UMB website for details. Fees are subtracted from your HSA Base Account balance.

HSA Base Account
The UMB HSA Base Account is an interest-bearing deposit account with an optional Money Market
Sweep feature. This FDIC-insured account is maintained in your name at UMB Bank. All contributions to
the HSA will be initially credited to the Base Account, and all distributions from the HSA will be

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Health Savings Account (HSA) – Plan Details


withdrawn from the Base Account. Funds in this account are owned entirely by you, the account holder,
and not subject to use-it-or-lose-it rules.

Balance-Based Interest Rates
The HSA Base Account will pay interest monthly according to UMB’s balance-based interest rate tiers.

Money Market Sweep Option
Once you exceed a $1,000 balance in the HSA Base Account, you may enroll in UMB’s automated
Money Market Sweep option, which may earn a higher interest rate than the Base Account.

Each night, funds in excess of $1,000 in the Base Account are automatically used to purchase shares of
the institutional money market fund. As ongoing contributions to the Base Account are made, additional
dollars are moved into this Sweep Account each night. Contributions cannot be made directly to the
Money Market Account.

There is no initial setup fee or ongoing account fee for the Money Market Sweep. Investments in the
money market fund:
• Are not FDIC insured;
• May lose value; and
• Have no bank guarantee.

Self-Directed Brokerage Account Option
The UMB HSA provides the opportunity to select and manage your investments through an online
brokerage account.

To open a Brokerage Account:
• A minimum balance of $1,000 in the HSA Base Account is required.
• Funds typically require an initial minimum investment of between $1,000 and $2,000.
• A fully functional brokerage window and additional online tools are available to help manage your
    account.
• All interest and earnings from the sale of securities is returned to the HSA Base Account balance.
• You will need to create a separate user name and password when opening a Brokerage Account.

Funds: More than 170 mutual funds are available in seven nationally recognized fund families: AIM
Funds, American Funds, Federated Investments, Fidelity Investments, Franklin Templeton Investments,
Oppenheimer Funds, and UMB Scout Funds. All funds are no-load funds offered at net asset value
(NAV).

Self-Directed Brokerage Account Option has a standard fee for any initial investment, as well as a
reduced fee for recurring transactions. See the UMB website for details. Fees are subtracted from your
HSA Base Account balance.

Investments in securities offered through the brokerage account:
• Are not FDIC insured;
• May lose value; and
• Have no bank guarantee.

Limited Use Flexible Spending Account (FSA)

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Health Savings Account (HSA) – Plan Details


A Limited Use Flexible Spending Account (FSA) is a flexible spending account option for employees
enrolled in an HSA. The Limited Use FSA applies only to eligible dental and vision expenses. Under IRS
rules, you are not eligible to contribute to an HSA and be enrolled in a general purpose Health Care
Spending Account at the same time.

Benefits of a Limited Use FSA
•  Health plans typically do not cover most dental and vision expenses nor do they count toward your
   deductible (see your health plan for details).
• Enrolling in a Limited Use FSA allows you the flexibility to use FSA dollars for dental and vision
   expenses, while preserving your HSA funds for other purposes, including simply saving those funds
   for the future.
Note: For the FSA: You must be able to provide proof that an expense is eligible through YSA. For the
HSA: It is solely your responsibility to retain receipts and records of reimbursements for tax purposes.

Using the YSA Card
•   If you enrolled in the Limited Use FSA and the UMB HSA:
              o    Dental and vision expenses will be deducted first from your Limited Use FSA balance.
              o    Medical expenses will be deducted from your HSA balance.
•   This “stacked” feature allows the Limited Use FSA balance to pay first for any dental and vision
    expenses. Once the Limited Use FSA balance is depleted, then dental and vision expenses are
    automatically deducted from your HSA balance.

Eligible Expenses2                         Limited Use FSA                              HSA
Approved prescription and health           No                                           Yes
care supplies
Medical copays and deductibles             No                                           Yes
Dental Services                            Yes                                          Yes
Vision care products                       Yes                                          Yes

    1.   The “stacked” feature of the YSA card is only applicable to those employees enrolling in the UMB HSA and the YSA
         Limited Use FSA. If enrolled in an HSA delivered through another bank, the YSA card will only reflect your Limited Use
         FSA balance.
    2.   When using the YSA card, funds will always be drawn from your Limited Use FSA balance first, where applicable, to
         preserve your HSA dollars.


YSA Card Frequently Asked Questions
What can I purchase with my card?
Use your Health Savings Account debit card to pay for eligible health care expenses. It should only be
used at health care-related locations.

Should I select “Debit” or “Credit” when asked by a merchant or directed by a point of sale system
to choose a payment method?
When making a purchase using a keypad or screen, choose “Credit.” No PIN number is required.

What happens if my health care provider does not accept Debit cards?
You’ll need to use another payment method (cash, check or credit card) for your purchase, then submit a
request for reimbursement on the YSA website. You can simply transfer funds from your HSA to your
personal checking or savings account.

Can I use my card to buy health care-related items from Internet merchants?
Yes, as long as your purchases are for eligible health care expenses.


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Health Savings Account (HSA) – Plan Details


Is the YSA card like other debit cards?
No. Your YSA card can only be used for eligible expenses with health care-related merchants. You
cannot access cash.


What if my card doesn’t work at the point of sale or my transaction is declined?
You may have to pay with another form of payment. You may not be visiting an eligible health care-
related merchant or your HSA balance may be too low to pay for the transaction.

What if I don’t have necessary HSA funds to cover the eligible health care purchases I need to
make?
Your transaction will be denied if your account has insufficient funds. You can either use another
payment method (cash, check or credit card) or pay a portion of the transaction with your remaining HSA
funds and pay the balance using another payment method.

What should I do if my card is lost or stolen?
Contact Your Spending Account Customer Service immediately at 1-800-350-0580. After business hours,
call 1-866-438-5797.

Do I need to save my itemized receipts?
It’s always a good idea to retain your itemized receipts as proof of eligible purchases. If the IRS asks you
to prove your HSA expenses were only used for eligible medical expenses, you will need these receipts.

A Final Note
Benefits Information – U.S. provides highlights of the Bank’s benefit plans. While every effort was made
to ensure its accuracy, it does not provide every plan detail, limit or exclusion. The plan documents,
which govern these plans, provide full details. The bank reserves the right to modify, amend, replace or
discontinue any benefit or plan at any time for any reason. If there are any discrepancies between this
guide and the legal plan documents, the plan documents shall rule.

Your Spending Account is a trademark of Hewitt Associates LLC.
Funds in an HSA Base Account are held at UMB Bank, N.A., Member FDIC.




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