DEPOSIT AGREEMENT & DISCLOSURE STATEMENTMassachusetts • September 4th, 2007
Jurisdiction FiledSeptember 4th, 2007A Medicare Advantage Medical Savings Account (“MSA” or “Medical Savings Account”) is an individually owned checking-with-interest account at Mellon Trust of New England, N.A. (referred to in this document as “us” “we”, “our” and similar terms). Medical Savings Account holders (referred to in this document as “you”, “your”, and similar terms) cannot make deposits into the Medical Savings Account. Medicare, by way of your Medicare Advantage Health Plan, will deposit funds (as part of your Medicare Advantage benefits) by check or electronic transfer into your MSA. Your Medicare Advantage Health Plan, on behalf of the Centers for Medicare and Medicaid Services (“CMS”), is the only entity that can make this deposit; such deposits will be made only once per year. Withdrawals from the Medical Savings Account can be made by way of check or electronic transfer. By opening a Medical Savings Account with us (your “Account”) and providing us with a signed Medical Savings Account Master Signature C