Once a year, an employee is asked to make a complicated, high stakes decision that could impact their life, financial wellbeing, and the lives and health of their families. This 5-minute tutorial is designed to help you make sense of your health plan options.

1. An Introduction to
Health Plans

2. What You’ll Learn
5-MINUTE TUTORIAL
Understanding Health Plans
The Differences in Plan Types
About Tax-Advantaged Accounts
Online Resources
2

3. Understanding Health Plans
First, let’s define common health plan terms.
3
BENEFITS EDUCATION

4. Open Enrollment
Open enrollment is an annual period when you can sign up for or
change your health insurance plan or benefit program.
This is a once-a-year opportunity unless you have a “qualifying life
event.”
A change in circumstance—like getting married or divorced, having
or adopting a baby, or losing health insurance coverage—makes
you eligible for a special enrollment period.
A qualifying life event is the exception to the once-a-year rule.
4
BENEFITS EDUCATION

5. Deductible
Out-of-Pocket Max
Doctor Visit
Specialist
Emergency Room
Rx Coverage - Retail
Coverage (BASIC IN-NETWORK)
$ 0
$ 2,500 / $ 5,000
$ 20 copay
$ 20 copay
$ 100 copay
$ 10 / $ 25 / $ 45
5
Premium
You pay no matter what. This is a fixed amount that automatically comes out
of your paycheck every month.
It’s like having gym membership dues. You pay for the right to go – regardless
of whether you use it.
Self Only
+ Spouse
+ Child(ren)
+ Family
$ X
$ X
$ X
$ X
Cost / Month
Plan Name
EX AMPLE PLAN OPTION

6. 6
Deductible
The amount of money you have to pay out-of-pocket for services and
procedures before your insurance kicks in to pay a portion of covered
benefits.
In general, the more you pay in premiums, the lower your deductible.
Deductible
Out-of-Pocket Max
Doctor Visit
Specialist
Emergency Room
Rx Coverage - Retail
Coverage (BASIC IN-NETWORK)
$ 0
$ 2,500 / $ 5,000
$ 20 copay
$ 20 copay
$ 100 copay
$ 10 / $ 25 / $ 45
Self Only
+ Spouse
+ Child(ren)
+ Family
$ X
$ X
$ X
$ X
Cost / Month
Plan Name
EX AMPLE PLAN OPTION

7. 7
Out-of-Pocket Max
This is the maximum amount of money you may have to pay in a given plan
year for covered services in your plan. Your deductible, copays, and
coinsurance count towards this limit (premiums don’t count).
Stay in-network whenever possible!
Deductible
Out-of-Pocket Max
Doctor Visit
Specialist
Emergency Room
Rx Coverage - Retail
Coverage (BASIC IN-NETWORK)
$ 0
$ 2,500 / $ 5,000
$ 20 copay
$ 20 copay
$ 100 copay
$ 10 / $ 25 / $ 45
Self Only
+ Spouse
+ Child(ren)
+ Family
$ X
$ X
$ X
$ X
Cost / Month
Plan Name
EX AMPLE PLAN OPTION

8. 8
Copay
A fixed amount of money you owe for your share of covered services and
procedures in your plan. Doctor visits and prescriptions commonly charge a
copay.
Deductible
Out-of-Pocket Max
Doctor Visit
Specialist
Emergency Room
Rx Coverage - Retail
Coverage (BASIC IN-NETWORK)
$ 0
$ 2,500 / $ 5,000
$ 20 copay
$ 20 copay
$ 100 copay
$ 10 / $ 25 / $ 45
Self Only
+ Spouse
+ Child(ren)
+ Family
$ X
$ X
$ X
$ X
Cost / Month
Plan Name
EX AMPLE PLAN OPTION

9. 9
Coinsurance
A percentage you have to pay on the total cost of services and procedures in
your health plan. For example 10% coinsurance on a $100 bill means you
pay $10 while insurance pays the other 90%.
Self Only
+ Spouse
+ Child(ren)
+ Family
$ X
$ X
$ X
$ X
Deductible
Out-of-Pocket Max
Doctor Visit
Specialist
Emergency Room
Rx Coverage - Retail
Coverage (BASIC IN-NETWORK)Cost / Month
$ 0
$ 2,500 / $ 5,000
$ 20 copay
$ 20 copay
$ 100 copay
$ 10 / $ 25 / $ 45
Plan Name
EX AMPLE PLAN OPTION

10. Knowing the difference between plan types and their networks can help
you choose the best plan for your needs and preferences.
Plan design can vary widely by employer.
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HMO EPO
H M O : H e a l t h M a i n t e n a n c e O r g a n i z a t i o n
E P O : E x c l u s i v e P r o v i d e r O r g a n i z a t i o n
P P O : P r e f e r r e d P r o v i d e r O r g a n i z a t i o n
Plan Types
Self Referral
Primary Doc Referral
No coinsurance
No deductible
Out of Network Coverage
PPO
Varies by
plan.
Varies by
plan.
Varies by
plan.
Varies by
plan.

11. Tax-Advantaged Accounts
Don’t pay taxes on qualified health expenses!
11
BENEFITS EDUCATION

12. 12
Health Savings Account (HSA)You
Own
It
Funds
Roll
Over
Pairs only
with an
HDHP
HSA 2019 2018
Contribution Limit
(employee + employer)
Individual only:
$3,500
Family: $7,000
Individual only:
$3,500
Family: $7,000
Catch-Up Contribution
(age 55 or older by year end)
$1,000 $1,000
An employee-owned, tax advantaged savings account. Use it to pay
for qualified health expenses not covered by your plan—or, you can
grow your funds to use in retirement.
“Think of an HSA like having a
health 401(k) you can dip into
now—or, let it build to pay for
qualified health expenses after
you retire.”
To be eligible for an HSA, you must have a High Deductible Health
Plan (HDHP)—also known as a “consumer-driven health plan”.

13. 13
An employer-owned, tax-advantaged spending account that you can
use to pay for qualified medical, dental, and vision expenses.
Health FSA 2019 2018
Health FSA Max.
Election
Not yet announced
(as of 7/6/18).
$2,650
Employer
Owns
It
Use it
or
Lose it*
Pairs
with All
Plans
Health
Flexible Spending Account (FSA)
GENERAL PURPOSE FSA
* Grace Periods and Carryovers
FSAs operate under a "use it or lose it" rule, meaning if you don’t use the
money in your FSA by the end of the plan year, the money will be
forfeited. However, the IRS allows employers to choose one of two
options (or neither):
1. Rollover up to $500 of unused funds, or
2. Provide a 2.5 month grace period (to spend down funds)

14. 14
It’s surprisingly long list, defined by the IRS in Publication 502:
• Medical care expenses must be primarily to alleviate or prevent
a physical or mental disability or illness. They don't include
expenses that are merely beneficial to general health, such as
[non-prescription] vitamins or a vacation.
• These expenses include payments for legal medical services
rendered by physicians, surgeons, dentists, and other medical
practitioners. They include the costs of equipment, supplies, and
diagnostic devices needed for these purposes.
• Medical expenses include the premiums you pay for insurance
that covers the expenses of medical care, and the amounts you
pay for transportation to get medical care.
Qualified Medical Expenses
HSA / FSA REIMBURSABLE COSTSJUST A FEW EX AMPLES
Acupuncture
Addiction Treatment
Ambulance
Bandages
Birth Control Pills, Vasectomy
Breast Pump
Capital Expenses (like door ramps)
Chiropractor
Contact Lenses
Dental Treatment
Disabled Dependent Care
Eye Exam, Eyeglasses, Eye Surgery
Fertility Enhancement
Hearing Aids
Insurance Premiums
Nursing Home/Services
Prescriptions
Psychiatric Care
Special Education
Transportation Costs for Medical Care

15. 15
An employer-owned, tax advantaged spending account that you can
use on qualified dental and vision health expenses.
Limited Purpose FSA 2019 2018
Limited FSA Max. Election
Not yet announced
(as of 7/6/18).
$2,650
Employer
Owns
It
Use it
or
Lose it
Pairs
with an
HSA
Limited Purpose
Flexible Spending Account (LPFSA)
DENTAL & VISION
Pairing a Limited Purpose FSA with
your Health Savings Account (HSA):
1. Increases the pool of tax-free
funds you have available for
qualified health expenses, and
2. Allows you to spend from this
account (and save more money in
your HSA).

16. 16
An employer-owned, tax-advantaged spending account that you can
use to pay for qualified child and elder health expenses.
Dependent Care FSA 2019 2018
Dependent Care FSA
Max. Election
Not yet
announced
(as of 7/6/18).
$2,500 if you file taxes as
single or married and filing
separately.
$5,000 if you file as head of
household (HOH) or married
and filing jointly
Employer
Owns
It
Use it
or
Lose it
Pairs
with All
Plans
Dependent Care
Flexible Spending Account (DCFSA)
CHILD & ELDER CARE
IRS REQUIREMENT: You (and your spouse if filing jointly) must have W-
2 earned income during the year. See IRS Publication 503.

17. 17
Employer
Owns
It
Use it
or
Lose it
(generally)
Pairs
with All
Plans
Health Reimbursement Arrangement
(HRA)
An employer-owned, tax-advantaged notional spending account
available to pay for your qualified healthcare expenses.
Contributions are made solely by your employer.
HRA 20XX
Employer contribution $ (determined by employer)

18. Click here to search Lumity’s Employee Benefits Resource
Center. These are just a few articles you’ll find:
• High vs low deductible plan
• How to compare plans
• 9 tips to reduce your healthcare costs
• HSA, FSA, HRA comparison table
• Switching from an FSA to an HSA
• Prior authorization for prescription drug
• Precertification for medical services
• COBRA coverage
• And so much more!
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Online Resources
QUESTIONS?

19. Our Story
Once a year, an employee is asked to make a complicated, high
stakes decision that could impact their life, financial wellbeing,
and the lives and health of their families. Lumity was founded by
two friends who thought they’d chosen well. And, in hindsight,
they would’ve made different choices.
Lumity’s mission is to help employers and employees choose
better. We combine data and expert benefits support so
employers pay fair rates and their people have better outcomes.
Senthil Nagaranjan, COO
Tariq Hilaly, CEO