Common use of Contribution Eligibility Clause in Contracts

Contribution Eligibility. You are an eligible individual for any month if you (i) are covered under an HDHP on the first day of such month; (ii) are not also covered by any other health plan that is not an HDHP and that provides coverage for any benefit covered under the HDHP (with limited exceptions such as a Limited Purpose Health Flexible Spending Account); (iii) are not enrolled in Medicare; and (iv) are not claimed as a dependent on another person’s tax return. In general, an HDHP is a health plan that satisfies certain requirements with respect to deductibles and out-of-pocket expenses, as adjusted for inflation. For calendar year 2015, for self-only coverage, an HDHP has an annual deductible of at least $1,300 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co-payments and amounts other than premiums) cannot exceed $6,450. For calendar year 2016, for self-only coverage, an HDHP has an annual deductible of at least $1,300 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co- payments and amounts other than premiums) cannot exceed $6,550. For calendar year 2015, for family coverage, an HDHP has an annual deductible of at least $2, 600 and the sum of the annual out-of-pocket expenses cannot exceed $12, 900. For calendar year 2016, for family coverage, an HDHP has an annual deductible of at least $2,600 and the sum of the annual out-of-pocket expenses cannot exceed $13,100. All of these dollar amounts are adjusted for cost-of-living increases.

Contribution Eligibility. You are an eligible individual for any month if you (i) are covered under an HDHP on the first day of such month; (ii) are not also covered by any other health plan that is not an HDHP and that provides coverage for any benefit covered under the HDHP (with limited exceptions such as a Limited Purpose Health Flexible Spending Account); (iii) are not enrolled in Medicare; and (iv) are not claimed as a dependent on another person’s tax return. In general, an HDHP is a health plan that satisfies certain requirements with respect to deductibles and out-of-pocket expenses, as adjusted for inflation. For calendar year 20152013, for self-only coverage, an HDHP has an annual deductible of at least $1,300 1,250 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co-payments and amounts other than premiums) cannot exceed $6,4506,250. For calendar year 20162014, for self-only coverage, an HDHP has an annual deductible of at least $1,300 1,250 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co- co-payments and amounts other than premiums) cannot exceed $6,5506,350. For calendar year 20152013, for family coverage, an HDHP has an annual deductible of at least $2, 600 2,500 and the sum of the annual out-of-pocket expenses cannot exceed $12, 90012,500. For calendar year 20162014, for family coverage, an HDHP has an annual deductible of at least $2,600 2,500 and the sum of the annual out-of-pocket expenses cannot exceed $13,10012,700. All of these dollar amounts are adjusted for cost-of-living increases.

Contribution Eligibility. You are an eligible individual for any month if you (i) are covered under an HDHP on the first day of such month; (ii) are not also covered by any other health plan that is not an HDHP and that provides coverage for any benefit covered under the HDHP (with limited exceptions such as a Limited Purpose Health Flexible Spending Account); (iii) are not enrolled in Medicare; and (iv) are not claimed as a dependent on another person’s tax return. In general, an HDHP is a health plan that satisfies certain requirements with respect to deductibles and out-of-pocket expenses, as adjusted for inflation. For calendar year 2015, for self-only coverage, an HDHP has an annual deductible of at least $1,300 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co-payments and amounts other than premiums) cannot exceed $6,450. For calendar year 2016, for self-only coverage, an HDHP has an annual deductible of at least $1,300 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co- payments and amounts other than premiums) cannot exceed $6,550. For calendar year 2015, for family coverage, an HDHP has an annual deductible of at least $2, 600 and the sum of the annual out-of-pocket expenses cannot exceed $12, 90012,900. For calendar year 2016, for family coverage, an HDHP has an annual deductible of at least $2,600 and the sum of the annual out-of-pocket expenses cannot exceed $13,100. All of these dollar amounts are adjusted for cost-of-living increases.

Contribution Eligibility. You are an eligible individual for any month if you (i) are covered under an HDHP on the first day of such month; (ii) are not also covered by any other health plan that is not an HDHP and that provides coverage for any benefit covered under the HDHP (with limited exceptions such as a Limited Purpose Health Flexible Spending Account); (iii) are not enrolled in Medicare; and (iv) are not claimed as a dependent on another person’s tax return. In general, an HDHP is a health plan that satisfies certain requirements with respect to deductibles and out-of-pocket expenses, as adjusted for inflation. For calendar year 20152013, for self-only coverage, an HDHP has an annual deductible of at least $1,300 1,250 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co-payments and amounts other than premiums) cannot exceed $6,4506,250. For calendar year 20162014, for self-only coverage, an HDHP has an annual deductible of at least $1,300 1,250 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co- payments and amounts other than premiums) cannot exceed $6,5506,350. For calendar year 20152013, for family coverage, an HDHP has an annual deductible of at least $2, 600 2,500 and the sum of the annual out-of-pocket expenses cannot exceed $12, 90012,500. For calendar year 20162014, for family coverage, an HDHP has an annual deductible of at least $2,600 2,500 and the sum of the annual out-of-pocket expenses cannot exceed $13,10012,700. All of these dollar amounts are adjusted for cost-of-living increases.

Contribution Eligibility. You are an eligible individual for any month if you (i) are covered under an HDHP on the first day of such month; (ii) are not also covered by any other health plan that is not an HDHP and that provides coverage for any benefit covered under the HDHP (with limited exceptions such as a Limited Purpose Health Flexible Spending Account); (iii) are not enrolled in Medicare; and (iv) are not claimed as a dependent on another person’s tax return. In general, an HDHP is a health plan that satisfies certain requirements with respect to deductibles and out-of-pocket expenses, as adjusted for inflation. For calendar year 20152012, for self-only coverage, an HDHP has an annual deductible of at least $1,300 1,200 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co-payments and amounts other than premiums) cannot exceed $6,4506,050. For calendar year 20162013, for self-only coverage, an HDHP has an annual deductible of at least $1,300 1,250 and the sum of the annual out-of-pocket expenses required to be paid (deductibles, co- co-payments and amounts other than premiums) cannot exceed $6,5506,250. For calendar year 20152012, for family coverage, an HDHP has an annual deductible of at least $2, 600 2,400 and the sum of the annual out-of-pocket expenses cannot exceed $12, 90012,100. For calendar year 20162013, for family coverage, an HDHP has an annual deductible of at least $2,600 2,500 and the sum of the annual out-of-pocket expenses cannot exceed $13,10012,500. All of these dollar amounts are adjusted for cost-of-living increases.