Personal Funding Accounts

HSAs are employee-owned, tax-advantaged, fully portable accounts that work in combination with a qualified, high- deductible health plan. In an HSA plan:

• Employee contributions are made pre-tax, meaning tax savings for both employee and employer
• Employees pay for all medical and pharmacy expenses- either out-of-pocket or with their HSA funds- until they meet their annual deductible. The plan pays 100% of expenses for the rest of the year
• The plan pays 100% for covered preventive care and certain preventive prescription drugs from day one

With an HSA, employees can:

• Enjoy lower monthly rates (due to higher annual plan deductibles)
• Save tax free for current and future medical costs
• Invest HSA contributions in a variety of mutual funds- with no transaction fees
• Choose whether and when to withdraw funds, tax-free, to pay for qualified medical expenses
• Use funds without penalty for non-medical expenses if they are 65 or older, or if they become permanently disabled (taxes apply to funds withdrawn in these instances)
• Carry unused funds from year to year, allowing funds to grow tax-deferred

Explore more:

Learn more about HSAs

HSA Calculator

FSAs are employer-sponsored, tax-advantaged healthcare spending accounts that members can use to pay for eligible expenses. With an FSA:

• Employee contributions are made pre-tax
• Employer contributions are tax-deductible
• Funds do not roll over for future use, but are “use it or lose it”
• The employer is not permitted to refund any part of the balance to the employee

Learn more about FSAs

Forms are due by the 1st of the month

Completed enrollment materials for NEW GROUPS must be received at Premera for HRA and HSA products for small groups beginning coverage on the first of the following month to ensure eligibility is active on the start date.

Incomplete materials may delay group enrollment

Miss a deadline? Include a signed Late Enrollment Acknowledgement form if you're turning in forms past one of these dates:

• The 5th of the month-for new and renewing HRA and HSA plans

Use this checklist to make sure you have your paperwork in order and know how to enroll before the due date.

1. Complete the necessary enrollment forms. All forms are available at premera.com

   All Groups Complete These Forms

   Group Master Application up to 50

   Group Master Application Benefit Selections up to 50

   Personal Funding Account Enrollment & Change Application

   Waiver of Coverage Every eligible employee (members must include date of hire and prior coverage)

   Deductible Credit Form (include prior carrier's Explanation of Benefits)

   Late Enrollment Acknowledgement (if applicable)

   Additional Forms Required For HSA Plans

   2016 Funding Account Setup- For Metallic Groups

   2017 Funding Account Setup- For Metallic Groups

   Electronic Funding Authorization

   Additional Forms Required For HRA Plans

   2016 Funding Account Setup- For Metallic Groups

   Electronic Funding Authorization

   ERISA Business Associate Agreement - For Metallic Plans

   Non-ERISA Business Associate Agreement- For Metallic Plans

2. Be sure to include a check for the first month's health plan bill payable to Premera Blue Cross
3. Return completed enrollment materials to your Premera account manager at:
   Be Returned To The General Agency Partner:
   Premera Blue Cross Blue Shield of Alaska
   2550 Denali St #1404
   Anchorage, AK 99503

Use this checklist to make sure you have your paperwork in order and your renewal is completed before the due date.

1. Complete the necessary enrollment forms. All forms are available at premera.com

   All Groups Complete These Forms

   Group Master Application up to 50

   Group Master Application Benefit Selections up to 50

   Personal Funding Account Enrollment & Change Application

   Waiver of Coverage Every eligible employee (members must include date of hire and prior coverage)

   Electronic Funding Authorization

   Additional Forms Required For HRA Plans

   2016 Funding Account Setup - For Metallic Groups

   Electronic Funding Authorization

   ERISA Business Associate Agreement- For Metallic Plans

   Non-ERISA Business Associate Agreement- For Metallic Plans

2. Return completed enrollment materials to your Premera account manager at:
   Be Returned To The General Agency Partner:
   Premera Blue Cross Blue Shield of Alaska
   2550 Denali St #1404
   Anchorage, AK 99503

Premera has partnered with UMB Bank to provide a unique banking experience. Unlike any other HSA health plan or HSA qualified bank, Premera and UMB Bank work together to offer our members comprehensive online access of HSA activity. In addition, our relationship with UMB Bank means we make saving and paying for qualified medical expenses with an HSA simple. We've included some helpful UMB member forms and information for your convenience.

UMB Bank Member Forms

UMB HSA Beneficiary Designation Form

UMB HSA Name Change Request Form

UMB HSA Account Closure/Withdrawal Request

UMB HSA Funds Transfer

HSA Expense Manual Claim Form

Bank Information

UMB Bank Fact Sheet

UMB Financial Services Fact Sheet

UMB Annual Report

UMB Welcome Letter

UMB Terms and Conditions

UMB Bank, member of the FDIC, is one of the largest independent banks in America since 1913. They have been an industry leader in financial healthcare accounts since 1997.