YOUR CIGNA CHOICE FUND®

HEALTH SAVINGSACCOUNTTAXES

PLAN YEAR: 2015

838559 d Offered by: Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company

HEALTH SAVINGS PLAN AND YOU

• A tax-advantaged health plan that provides coverage for current health care expenses with the option to save for future health care expenses

• Combines a qualified high deductible medical plan (medical/pharmacy coverage) with a Health Savings Account

• You, your employer or both can contribute to the Health Savings Account which is owned by you

• Money put in the Health Savings Account is generally not taxable*• You have investment options with the Health Savings Account

+ =Qualified high deductible medical plan

Tax-advantagedHSA Plan

Health Savings Account

* HSA contributions and earnings are not subject to Federal taxes and not subject to state taxes in most states. A few states do not allow pretax treatment of contributions or earnings. Please consult your personal tax advisor or contact your plan administrator for information about your state.

3Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

Refresher on HSA Basics

Health Savings Account (HSA)

What is a Health Savings Account?

Who May Contribute?

An HSA is a tax-advantaged health savings account. The money deposited into the account can be used to pay for qualified medical expenses.

Individual/Employee and Employer

Who Owns Account? Individual/Employee*

Maximum Contributions (2015)

(Employee & SPU)

Individual - $3,350

Family - $6,650

How is maximum calculated? Based on CDHP enrollment tier selected

Additional Contributions AllowanceAllowed for persons age 55 and older “catch up” contribution $1,000

Portable? Yes

Rollover of Funds? Yes

Tax Status of Employee ContributionsExempt from Federal Taxes and exempt from State taxes in all states except CA, NJ, NH & AL

Special Rules for MarriageTotal contribution to HSA cannot exceed the family maximum if both spouses have an HSA

*JPMC accountholders are charged a monthly maintenance fee of $1.85

The IRS has set the following limits for 2015:

• Under age 55 and not enrolled in Medicare (based on a 12-month period):

– Up to $3,350 individual coverage*

– Up to $6,650 family coverage*

• Age 55 or older:

– Maximum contribution increases by $1,000 (considered a “catch-up” contribution)

– Up to $4,350 individual coverage*

– Up to $7,650 family coverage*

• To make the maximum contribution in a calendar year, you must:

– Meet all requirements to be eligible for HSA contributions on January 1

– Remain qualified through December 1

– If these criteria are not met, maximum contribution is prorated = if 1/12 maximum contribution for each month then individual is qualified

YOUR HSA MAXIMUM CONTRIBUTION***

*Contributions to your HSA that you receive from your employer and incentives count toward your maximum.

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As an HSA accountholder, every year you may receive two forms from JPMorgan Chase Bank

•1099-SA•5498-SA

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Form 1099-SA

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Form 1099-SA

Do I have to report information on Form 1099-SA on my federal income tax return?

Yes. You must report distributions (all money spent from HSA) from your HSA on IRS Form 8889.

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Form 1099-SA

• Box 1: reports the total distributions made from your HSADistributions include any purchase or withdrawal using your HSA

• Box 2: reports any earnings on excess contributions.

Form 5498-SA

Form 5498-SA$

This form is for informational purposes and supports contributions already on your tax return

•Box 2: Reports total contributions to your HSA for 2013•Box 3: Reports for contributions made in 2014 for 2013.

How To Access JPMorgan Chase on myCigna.com

How To Access JPMorgan Chase on myCigna.com

Click here for JPMorgan Chase Website

Open to your Chase account page

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How to Access Forms

FEDERAL FORM 8889

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•Contributions

•Distributions

•Determination of Federal Taxes if:Non-Qualified DistributionsExcess HSA contributions

•Form availabilityhttp://www.irs.gov/pub/irs-pdf/f8889.pdf

Form 8889

Access your YTD Tax Year Summary link or your Year-End Statement to complete Form 8898

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• Additional information is available in IRS Publication 969 on the IRS website.

–www.irs.gov

–If you have additional questions about your HSA contributions or distributions, contact HSA Customer Service

–1-866-524-2483

Additional Questions?

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DISCLAIMER

Cigna HealthCare does not advise on any personal income tax requirements or issues. Use of any information from this presentation is for general information only and does not

represent personal tax advice either express or implied. You are encouraged to seek professional tax advice for personal income

tax questions and assistance.

“Cigna,” the “Tree of Life” logo, “GO YOU” and “Cigna Choice Fund” are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Tel-Drug, Inc., Tel-Drug of Pennsylvania, L.L.C., Cigna Onsite Health, LLC, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In California, HMO and Network plans are offered by Cigna HealthCare of California, Inc. In Connecticut, HMO plans are offered by Cigna HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by Cigna HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC. “Cigna Home Delivery Pharmacy” refers to Tel-Drug, Inc. and Tel-Drug of Pennsylvania, L.L.C. In Texas, Open Access Plus plans are considered Preferred Provider plans with certain managed care features. All models are used for illustrative purposes only.

838559d 07/13 © 2013 Cigna. Some content provided under license.

Product Disclosures

Rates will vary by plan design including the amount of plan deductibles, coinsurance, and out-of-pocket and lifetime maximums. Rates may vary based on age, gender, geographic location and the plan deductible selected.

All insurance policies and general service agreements have restrictions, exclusions, limitations, reductions of benefits and terms under which the policies or agreements may be continued in force or discontinued. Terms and conditions of coverage are set forth in the plan documents - the insurance certificate, plan booklet, policy, contract and/or summary plan description.