Health Savings Account Plan (HSA)

Participants in the HSA plans should submit claims to Mellon Bank as claims administrator.

The HSA Accounts are pre-tax savings accounts designed to save you taxes when you pay for certain eligible expenses that are not covered by other benefit plans. With these accounts, you can be reimbursed for expenses with money set aside from your earnings--money that is not subject to federal income or Social Security taxes. This can mean a substantial tax advantage for you. You may make Contributions to:

Health Savings Account for health care expenses (incurred by you and your eligible tax dependents) that are not eligible to be paid by insurance. This includes your annual deductible, coinsurance, dental, vision, and prescription costs. Available to individuals who enroll in the Value PPO.

Any remaining balance at the end of the calendar year will rollover and remain in your account

Upon initial enrollment into the plan, Northwestern will match dollar-for-dollar up to half of the contribution limit, which is the Value PPO deductible for a given year. Subsequent enrollments will not be matched by the University.

For example:	If you contribute...	NU Contributes...
You Only Coverage	$700	$700
*Family Coverage	$1400	$1400

*Family coverage includes: you+spouse, you+child(ren) and you+spouse+child(ren).

� Northwestern is allowing you to contribute the annual deductible for the Value PPO to the HSA account via payroll deductions. The IRS limits are higher. If you wish to contribute beyond the Value PPO deductible up to the IRS limit, you may do so by contacting Mellon Bank directly.

� Value PPO deductibles: Single $1,400, Family $2,800

� IRS Limits to the HSA for 2009: Single $3,000, Family: $5,950

� For individuals age 55 and older by December 31, 2009, additional �catch-up� contributions of $1,000 for 2009 are allowed and may be made via payroll deductions.

Contact Information:

HSA administered by Mellon Bank
Welcome Kit with signature card, checks & debit card will be sent to your home address after enrollment. You must register your account with Mellon Bank, please follow the instructions in the Welcome Kit.
https://hsamember.com
877-635-5472

Protection of Personal Health Information