Your Everyday Guide to Using Your 2025 HSA Medical Plan Benefits 1 of 39
Before You Go ..............................................3 How Your Medical Plan Works . . . . . . . . . . . . . . . 4 ID Cards and HSA Debit Card . . . . . . . . . . . . . . . 5 Find the Right Doctor . . . . . . . . . . . . . . . . . . . . . . . 8 Prepare for Your Doctor’s Visit . . . . . . . . . . . . . . . 9 KnowWhattoAskYourDoctor. . . . . . . . . . . . . . 9 Know What to Do After Your Visit. . . . . . . . . . . 10 Know Where to Get the Right Care . . . . . . . . . . 11 How You Pay for Care..............................12 100%-Paid Preventive Care . . . . . . . . . . . . . . . . 13 AnnualDeductible.........................14 Know When Your Deductible Applies . . . . 14 Out-of-Pocket Maximum . . . . . . . . . . . . . . . . . . . 15 Paying for Prescription Drugs . . . . . . . . . . . . . . . 16 100%-Paid Prescription Drugs . . . . . . . . . . 17 UsingtheHSAPlan........................18 First,FundYourHSA....................18 Then,UseIttoPayforCare.. . . . . . . . . . . . . 19 Eligible Out-of-Pocket Expenses . . . . . . . . 19 Your HSA in Action: How It Works . . . . . . . 20 Changing Your HSA Contribution Amount . . . 22 Special Programs and Services.........23 Teladoc Health Telemedicine . . . . . . . . . . . . . . . . 24 Teladoc Health Mental Health . . . . . . . . . . . . . . . 25 2nd.MD...................................26 AccessHope...............................26 Transcarent Surgery Care.. . . . . . . . . . . . . . . . . . 28 Blue Cross of Idaho Programs.. . . . . . . . . . . . . . 29 CareManagement......................29 SmartShopper . . . . . . . . . . . . . . . . . . . . . . . . . 30 Resources for Mental and Emotional Health . . 31 Employee Assistance Program . . . . . . . . . . . 31 Benefits Through Blue Cross of Idaho ....32 RethinkCare............................33 Learn More..................................................34 Making Benefit Changes (QualifyingLifeEvents).. . . . . . . . . . . . . . . . . . . . 35 COBRA Continuation Coverage . . . . . . . . . . . . . 36 myACI Benefits Resources Page ............37 MyACI-Benefits.com Website ...............38 U seful Mobile Apps (Blue Cross of Idaho, Teladoc, MedImpact, Fidelity, myStrength) . . . 38 ContactInformation........................39 2 of 39 How to Use This Guide This booklet offers you practical guidance for making the most of the Health Savings Account (HSA) Plan. In these pages, you will find: • Basic information like how to find a doctor, how to prepare for and access the right care and care follow-up • How much you can expect to pay for care with important definitions and helpful examples • Descriptions of special programs and services for a variety of health conditions and care delivery • Instructions for making changes to your plan, continuing coverage when you leave Albertsons or become ineligible, accessing myACI-Benefits.com, available mobile apps and more For medical plan details, as well as information about ALEX (your interactive benefits counselor), please refer to the 2025 Benefits Guide. See page 37 for more on myACI benefits resources. Table of Contents
3 of 39 Before You Go Going to the doctor is a major part of staying healthy, so it is a good idea to make the most of it. Before You Go How You Pay for Care Special Programs and Services Learn More
How Your Medical Plan Works 4 of 39 For all you do, the Company offers comprehensive benefit plans to support you. Learn how your medical plan works, so you can make the most of the highquality coverage the Company provides. Important: Always Use In-Network Providers This guide is for associates who are enrolled in the HSA Plan. HSA stands for Health Savings Account. It’s important to understand that you will receive a much higher level of benefits when you use in-network providers: doctors and facilities that are part of the plan’s network. Paying for Your Medical Plan Coverage Your contribution (also called a rate or premium) is the amount you pay to have coverage under the Company’s medical plan. Your contribution is deducted from each weekly paycheck. Paying for Healthcare Deductible The annual deductible is the amount you pay out of your own pocket for covered medical services before the plan begins to pay benefits. The deductible resets every January 1. The HSA Plan has an aggregate deductible for family coverage. This means the entire family deductible must be met before the plan begins sharing costs with you for any covered family member. For more on the deductible, see page 14. Copays and Coinsurance Once you meet the deductible, you and the plan share costs for all covered healthcare expenses. For some healthcare services, you will pay a copay: a flat fee that you pay each time you see a doctor or fill a prescription. For other services, you will pay coinsurance, or a percentage of the cost. For example, “20% coinsurance” means that if the plan pays 80% of an expense, you are responsible for the remaining 20%. Out-of-Pocket Maximum The annual out-of-pocket maximum is the most you will have to pay for covered healthcare expenses out of your own pocket in a calendar year. If you meet the out-of-pocket maximum, the plan will cover 100% of your healthcare expenses for the rest of the year. Deductibles and coinsurance count toward your out-ofpocket maximum. For more on the out-of-pocket maximum, see page 15. Before You Go How You Pay for Care Special Programs and Services Learn More Take Care of Your Health with Preventive Care For certain services, like preventive care, you do not have to pay the deductible before the plan begins to pay benefits. Preventive care includes screenings, check-ups, patient counseling and other routine care intended to prevent health problems.
® Companies Enrollee Name / Number John Smith YSW123456789 Group Number 10036166 Medical HSA HSA Plan Deductible(Family) In-Network $4000 Out-of-Network $8000 Out-of-Pocket(Individual/Family) In-Network $6000/$12000 Out-of-Network $12000/$24000 Calltonotifyuswhenyouoraneligible dependent have a hospital inpatient admission. You should obtain prior authorization for certain hospital and non-hospital services. Failure to call may affect your benefits payment. Providers: Please file your claims with your local BlueCrossBlueShieldPlan.IfMedicare is primary, file Medicare claims with Medicare. For benefit and eligibility information, please call 1-866-482-2250. Blue Cross of Idaho provides Medical administrative claims payment services only and does not assume financial obligation for claims. Blue Cross of Idaho may reinsure some claims. For Customer Service, visit bcidaho.com or call the appropriate number below: Members: (855) 854-1412 Providers: (866) 482-2250 Prior Authorization: (800) 743-1871 TTY: (800) 377-1363 Guidance Resources (EAP): (877) 294-3271 Advanced Imaging Prior Auth: (866) 714-1105 BlueCard® Access: (800) 810-2583 (To find a provider) MedImpact*: (888) 402-1984 Teladoc*: (800) 835-2362 *Contracts directly with Group Blue Cross of Idaho P.O. Box 7408 Boise, Idaho 83707 An independent licensee of the Blue Cross and Blue Shield Association. 5 of 39 ID Cards and HSA Debit Card You may not think about your health insurance ID cards very often—until you, your doctor or another medical provider needs it. Your HSA Plan ID card, MedImpact prescription ID card and Fidelity HSA debit card are your passports to care and coverage, and you should know what all the important pieces of information mean. It is a smart practice to show your provider your ID card every time you visit even if you don’t think anything has changed. This way, you can make sure claims are processed correctly. What’s on My ID Card? FRONT 1 Your ID number and group number: Your healthcare providers need these numbers to verify your coverage and file claims for your doctor’s visits or other services. 2 Medical plan name: Here’s the official name of your medical plan. 3 Cost information: Your deductible and out-of-pocket maximum amounts are listed here. BACK The back of your ID card lists contact information for Blue Cross of Idaho, MedImpact (prescription drug coverage), Teladoc (telemedicine visits) and the Employee Assistance Program (free counseling and other support resources). 1 2 3 Before You Go How You Pay for Care Special Programs and Services Learn More
6 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More MedImpact Prescription Drug ID Card Your medical plan includes prescription drug benefits from MedImpact. You have a separate ID card for prescription drug coverage. Use your MedImpact ID card when you go to the pharmacy or order prescriptions online. FRONT 1 Important numbers: Your pharmacist needs these numbers to fill your prescription: – Rx BIN (banking identification number) – Rx PCN (processor control number) – Rx GRP (group number) – Your ID number 2 Date issued: The date your card was issued. BACK The back of your ID card lists contact information including MedImpact’s phone number and website, along with an address for submitting claims. 1 2
7 of 39 HSA Debit Card Your HSA debit card can be used to pay for eligible health care products and services. Don’t forget to save your receipts for your tax records. On your Fidelity HSA Debit Card you will find: FRONT 1 Magnetic Chip: Used to insert the card instead of swiping; makes the card more secure BACK 2 Bank Information: Contact information if you or a provider have questions for the bank 3 Magnetic Strip: Read by special readers when the card is swiped to make a transaction 4 Name: Cardholder name 5 Account Number: Connects card to a specific health savings account 6 Expiration Date: The date card is valid until 7 Verification Number: Three digit number used during purchases sometimes to prevent unauthorized transactions 2 1 4 6 3 5 7 Before You Go How You Pay for Care Special Programs and Services Learn More
8 of 39 When looking for a doctor or other healthcare provider for yourself or a loved one, it’s important to choose someone you can trust. Try the following tips to find one that’s right for you. Ask People You Know Getting a reference from someone you know and trust is a great way to find a doctor: • Ask friends, family members, neighbors or coworkers if they have a doctor they like. • If you are looking for a new doctor because yours is retiring or moving, ask your current doctor for a recommendation. Make Sure the Doctor Is in the Network 1. Go to https://www.bcidaho.com/albertsons-providers 2. Click on Search Providers 3. Under Just Browsing, click Continue 4. Enter your ZIP code and press Continue 5. Click on the network dropdown list and select the HSA Plan, then click Continue to find providers in your area Learn More About Your Choices Questions about the doctor: • Is the doctor taking new patients? • Is the doctor part of a group practice? If so, who are the other doctors that might help care for me? • Who will see me if my doctor isn’t available? • Which hospital does the doctor use? • Does the doctor have experience treating my medical conditions? • Does the doctor have special training or certifications? Find the Right Doctor Questions about the office: • Are evening or weekend appointments available? What about telemedicine (phone or video appointments)? • What is the cancellation policy? • How long will it take to get an appointment? • How long do appointments usually last? • Can I get lab work and X-rays done in the office? • Is there a doctor or nurse who speaks my preferred language? If you answered “no” to any of these questions, you may want to keep looking. Before You Go How You Pay for Care Special Programs and Services Learn More Think About Your Healthcare Experience Did the doctor and office staff: • Make me feel comfortable during my appointment? • Explain things in a way that was easy to understand? • Listen carefully to me? • Show respect for what I had to say? • Know important information about my medical history? • Spend enough time with me? • Give me a chance to ask questions?
9 of 39 A basic plan can help you make the most of your appointment, whether you are starting with a new doctor or continuing with the doctor you have seen for years. Make a List and Prioritize Your Concerns: Do you have a new symptom you want to ask the doctor about? Do you want to get a flu shot? Are you concerned about how a treatment is affecting your daily life? If you have more than a few items to discuss, put them in order and ask about the most important ones first. Don’t put off the things that are really on your mind until the end of your appointment—bring them up right away. Take Information with You to the Doctor: Put all your prescription drugs, over-the-counter medicines, vitamins, and herbal remedies or supplements in a bag and bring them with you. Or, bring a list of everything you take and the dose. You should also take your insurance cards, your HSA card, the names and phone numbers of other doctors you see, and your medical records if the doctor doesn’t already have them. Consider Bringing a Family Member or Friend to the Doctor’s Office: Let your family member or friend know in advance what you want from your visit. Your companion can remind you what you planned to discuss with the doctor if you forget. They can take notes for you and can help you remember what the doctor said. Keep Your Doctor Up to Date: Let your doctor know what has happened in your life since your last visit. If you have been treated in the emergency room or by a specialist, tell the doctor right away. Mention any changes you have noticed in your appetite, weight, sleep or energy level. Also, tell the doctor about any recent changes in any medications you take or the effects they have had on you. Prepare for Your Doctor’s Visit Before You Go How You Pay for Care Special Programs and Services Learn More Know What to Ask Your Doctor For convenience, below are links to worksheets to organize your questions, family and medical history, and information when talking with your doctor. Family Health History Worksheet: A family medical history can identify people with a higher-than-usual chance of having common disorders, such as heart disease, diabetes and more. Questions to Consider When Choosing a New Doctor: Use this worksheet to answer some questions for and about a new doctor you are considering. Life Changes to Discuss with Your Doctor Worksheet: It is important to tell your doctor about any changes in your life since your last appointment. Use this worksheet to help you record what you want to discuss with your doctor during your next visit. Prioritizing Concerns to Share with Your Doctor Worksheet: Use this form to help organize your thoughts about any health or other concerns you want to discuss with your doctor. Tracking Your Medications Worksheet: This worksheet can help you keep track of different medicines, including vitamins, over-the-counter drugs and prescriptions.
10 of 39 After your visit to the doctor, there are two things you should keep in mind—follow up and follow through. Follow up by scheduling your next appointment. For example, your doctor may ask you to come back in a few weeks or months so they can assess how your medicine is working. You can save time by booking that followup appointment before you leave the doctor’s office. If your doctor wants you to see a specialist, get some tests or get a second opinion, check with Blue Cross of Idaho to find out if a referral or pre-authorization is required. Pre-authorization means your doctor needs to authorize, or give approval for, certain healthcare services for Blue Cross of Idaho to cover those services. Checking with Blue Cross of Idaho ahead of time can help you avoid unexpected expenses. Follow through with recommended instructions or treatments. If you have questions or problems, don’t be afraid to call. If you had tests during your visit and have not heard back within the expected time frame, call your doctor. It is better to feel like a pest than to compromise your health. Let the doctor know if you feel the treatment is not working or if you are having any side effects, even if they seem minor to you. If you are unable to take your medications for any reason, be sure to let your doctor know right away, and don’t wait for a follow-up visit. Finally, call the doctor if your symptoms get worse or if something else, even unrelated, develops. Know What to Do After Your Visit Before You Go How You Pay for Care Special Programs and Services Learn More
11 of 39 When you need to see a medical provider, you may be uncertain about where to go for care, especially if your regular doctor is unavailable and you need immediate assistance. While the answer can be less than simple, knowing the features of the different kinds of care can save you money—and even save your life. If you are experiencing a life-threatening emergency, dial 911. Know Where to Get the Right Care Contact Teladoc Health if… Go to your regular doctor if… Go to urgent care if… Go to the emergency room if… … you want to connect with a doctor via phone or video consultation for a nonemergency medical issue. … you need routine medical care, continuation of care or treatment options. … you need immediate care but your primary care physician is unavailable. … you need serious medical care immediately at any time of day or night, 7 days a week. • General medical: flu, sinus infections, allergies • D ermatology: eczema, acne, rashes • M ental health: stress, anxiety, depression • N utrition: weight management, food allergies, meal planning Your share of the cost is just $20 per visit after annual deductible is met. • L ong-term medical conditions: — H igh blood pressure, diabetes, high cholesterol, wellness check-ups — Ongoing medication refills or adjustments • L ab work or diagnostic radiology • Specialist referral • M inor illnesses, such as cold and flu, fever, body aches, sore throat or earache • B ee stings, rashes or insect bites • Minor injuries • P hysicals for sports and work permits • C hest pain, shortness of breath or difficulty breathing • S troke-like symptoms such as weakness on one side of body, arm or leg, slurred speech or blurred vision • S evere or uncontrollable bleeding • S evere nausea, vomiting or diarrhea Before You Go How You Pay for Care Special Programs and Services Learn More Get Started with Teladoc Health Anytime, anywhere access to board-certified doctors: • Website: teladochealth.com • Phone: 800-TELADOC (835-2362) • Mobile app: App Store or Google Play For more on Teladoc Health, see page 24.
How You Pay for Care Let’s look at the types of expenses you pay as a participant in the HSA Plan—plus factors that can make those expenses higher or lower. 12 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More
13 of 39 100%-Paid Preventive Care Preventive care helps detect or prevent serious diseases and medical problems before they can become major healthcare issues. All Albertsons medical plans cover preventive care at no cost to you. For example, depending on your age, you may have access to no-cost preventive services such as: • Annual check-ups or physicals • Blood pressure, diabetes and cholesterol tests • Many cancer screenings, including mammograms and colonoscopies • C ounseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression and reducing alcohol use • Regular well-baby and well-child visits • R outine vaccinations against diseases such as measles, polio or meningitis • Counseling, screening and vaccines to ensure healthy pregnancies • Flu shots and other vaccines Important: For preventive care to be covered, you must use an in-network provider. Here is a complete list of Blue Cross of Idaho’s preventive care benefits. Before You Go How You Pay for Care Special Programs and Services Learn More What’s the difference between preventive care and diagnostic care? Preventive care includes tests, screenings and visits to help you stay healthy. Based on the results of a preventive care test or screening, your doctor might recommend diagnostic care services. Diagnostic care means your doctor is looking for more information to diagnose a specific health problem. For example, let’s say you get a mammogram. After reading the results, your doctor recommends a follow-up scan to confirm your diagnosis. The follow-up scan would be considered diagnostic care, so if you go to an in-network provider, you would pay 20% after meeting your deductible.
14 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Annual Deductible The annual deductible is the amount you pay out of your own pocket for covered medical services before the plan begins to pay benefits. The annual in-network deductible for the HSA Plan is: • Associate Only: $2,000 • Family: $4,000 The HSA Plan has an aggregate deductible, which is an important concept to understand if you are covering dependents. This means that the entire family deductible must be met before the plan shares costs with you for any covered family member. In other words, once the aggregate family deductible has been met, health insurance coverage kicks in for the entire family. There are two ways the aggregate deductible can be met: 1. As each member of the family uses and pays for healthcare services, the amount paid out-of-pocket for those services is credited toward the family’s aggregate deductible. After several family members have paid deductible expenses and the combined total of those in-network expenses reaches $4,000, the health plan then begins to share the cost of in-network healthcare expenses for all members of the family. 2. One member of the family has high healthcare expenses. The amount they pay out-of-pocket for those in-network expenses reaches $4,000. The health plan then begins to share the in-network healthcare expenses of the entire family, even though only one family member has paid anything toward the aggregate deductible. Note: The annual deductible for out-of-network benefits under the HSA Plan is higher than the in-network annual deductible. Know When Your Deductible Applies Your health insurance deductible and monthly premiums are probably your two largest healthcare expenses. Because your deductible counts for the lion’s share of your healthcare spending budget, understanding what counts toward your deductible and what doesn’t is important. Before your annual deductible is met, you pay for 100% of your medical bills, except for copays (e.g., $10 for a retail Generic prescription) and preventive care (always covered at no cost to you). After the deductible has been met, you pay only coinsurance or copayments (depending on the type of care or service) until you meet the out-of-pocket maximum (see “Out-of-Pocket Maximum” on the next page). What does not count toward the annual in-network deductible? There are a few healthcare expenses that do not count toward the deductible: • H ealthcare services not covered by the plan (e.g., cosmetic surgery for facial wrinkles) • Out-of-network care • Copayments (e.g., $10 copay for a retail Generic prescription) • Premiums deducted from your paycheck
15 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Out-of-Pocket Maximum The annual in-network out-of-pocket maximum is the most you will have to pay for covered healthcare expenses (out of your pocket) in a calendar year before the plan starts to pay 100% of covered in-network expenses. Deductibles and coinsurance count toward the out-of-pocket maximum. The in-network out-of-pocket maximum for the HSA Plan is: • Associate: $6,000 • Family: $12,000 After you meet the out-of-pocket maximum, the HSA Plan will pay for 100% of all in-network covered expenses. Note: The annual out-of-pocket maximum for out-ofnetwork benefits under the HSA Plan is higher than the in-network out-of-pocket maximum.
16 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Paying for Prescription Drugs Prescription drug coverage helps pay for prescription medications purchased from 1,700+ Company-owned pharmacies or a participating network pharmacy. MedImpact is the pharmacy benefit manager for the HSA Plan. Important: Your prescriptions will only be covered if you fill them at: • A Company-owned pharmacy (a pharmacy at a store that’s owned by Albertsons Companies) • A pharmacy that is in MedImpact’s network and located more than 10 miles away from a Company-owned pharmacy All Company-owned pharmacies are staffed with highly trained pharmacists and pharmacy technicians who treat your health with care and confidentiality. If you need help with finding a covered pharmacy, please contact MedImpact at 888-402-1984. Your Share of Prescription Drug Costs For Specified Preventive Drugs (see “100%-Paid Prescription Drugs” on next page), you pay $0, and your cost for Generic drugs is a $10 copay (Retail) or $30 copay (Mail Order). The cost of Brand Preferred and Brand Non-Preferred prescription drugs is treated like any other covered healthcare expense. The following table clarifies your share of the cost of prescription drugs. Your Share of the Cost for Prescription Drugs At-a-Glance (See “Things to Consider” on the next page for more information) Before you reach your medical deductible: After you reach your medical deductible and before you reach out-of-pocket maximum: After you reach the out-of-pocket maximum: Specified Preventive Drugs: You pay $0 Specified Preventive Drugs: You pay $0 Specified Preventive Drugs: You pay $0 Generic: You pay a $10 copay Generic: You pay a $10 copay Generic: You pay a $10 copay Brand Preferred: You pay 100% of network negotiated cost Brand Preferred: You pay 20% (min $30, max $90) of network negotiated cost Brand Preferred: You pay $0 Brand Non-Preferred: You pay 100% of network negotiated cost Brand Non-Preferred: You pay 30% (min $60, max $120) of network negotiated cost Brand Non-Preferred: You pay $0
17 of 39 Things to Consider • Specified preventive drugs: These are drugs specified on the essential drug list covered at 100% if filled at a Company or MedImpact network pharmacy. • Additional preventive drugs: Additional HSA Plan preventive drugs are covered at 100% based on a formulary. • Generic drugs: These drugs are sold under the drug’s chemical name and contain the same active ingredients and equivalent strength and dosage to the brand-name equivalent. • Brand Preferred drugs: You pay a lower cost for brandpreferred drugs on the drug formulary compared to brand nonpreferred drugs that are not on the drug formulary. • Brand Non-Preferred drugs: You pay the highest cost for brand non-preferred drugs that are not on the drug formulary. • Specialty medications: MedImpact’s in-house Specialty Care Services are available to help you fill prescriptions for select specialty medications. Specialty medications are for complex diseases like HIV, mental health, autoimmune disorders and cancer. If this applies to you, your pharmacist will connect you with the Specialty Care team. 100%-Paid Prescription Drugs There are numerous prescription drugs that are covered at 100% (no cost to you) even before you meet the annual deductible. These fall under one of two categories: • Affordable Care Act (ACA) Specified Preventive Drugs List • HSA Plan Additional Preventive Drugs (special feature available ONLY with the HSA Plan) Before You Go How You Pay for Care Special Programs and Services Learn More
18 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Using the HSA Plan First, Fund Your HSA With the HSA Plan, you may be eligible to contribute to a Health Savings Account (HSA) through Fidelity. There are several ways to add funds to your HSA: • Payroll Deduction: Albertsons lets you make HSA contributions through convenient payroll deductions. Contributions are deposited into your HSA on a pre-tax basis (before taxes are applied to your paycheck). • Bank Account: You can also link a bank account (e.g., checking or savings) for one-time or recurring deposits, or you can deposit a check. • HSA Consolidation: If you already have an HSA with a balance, you can transfer some or all of those funds to consolidate your accounts. • One-Time IRA Contribution: Regulations allow you to move money from an IRA to your HSA once in your lifetime for a federal income tax deduction. In order to be eligible to fund an HSA though Fidelity, you must be enrolled in an HSA-qualified health plan (like the HSA Plan), and you must not be enrolled in certain other types of coverage. Check with Fidelity to determine if you are eligible. Tax Savings Money you contribute to your HSA has a triple tax advantage*: It goes in tax-free (except funds transferred from a checking or savings account that have already been taxed), comes out tax-free (if you use it to pay for eligible healthcare expenses) and grows tax-free. * With respect to federal taxation only. Contributions, investment earnings and distributions may or may not be subject to state taxation. Flexibility and Ownership It is up to you how much to contribute (up to IRS limits—see table below) and when you want to use the money in your HSA. You can use it to pay for eligible healthcare expenses now or in the future—including in retirement. The money you don’t spend by year-end stays in your HSA and rolls over year to year, just like a regular savings account, and continues to build. There’s no “use it or lose it” rule. Plus, your HSA is yours to keep, even if you later decide to enroll in a medical plan without an HSA or if you leave Albertsons or retire. You can continue to use it to pay healthcare expenses now or in the future. You always own 100% of your HSA. Annual HSA Contribution Limits The IRS defines HSA contribution limits each year. Investing Your HSA Dollars You may have the option to invest your HSA contributions through Fidelity. Any earnings on your invested contributions can grow tax-free. You can also manage your invested HSA dollars through Fidelity. 2025 Associate Only $4,300 Family $8,550 Age 55 or Older Additional $1,000
Second, Use Your HSA to Pay for Care When you (or your dependents if you have family coverage) have qualified medical expenses that are not covered by the HSA Plan, you can pay for them tax-free with your HSA. There are three ways you can spend from your HSA: • Fidelity HSA Debit Card: Pay for qualified medical expenses anytime with a swipe of your card. • Fidelity Bill Pay: Receive and pay bills for qualified medical expenses with Fidelity’s free online service. • Reimbursement: Get money back for medical expenses you paid out of pocket. Eligible Out-of-Pocket Expenses You can use your HSA to pay for much more than just doctor visits and prescriptions. Qualified expenses include: For more information and a complete list of qualified medical expenses, see IRS Publication 502. At age 65, you can spend your HSA dollars on anything, not just medical expenses, and you won’t incur the 20% penalty. The withdrawal will just count toward your gross annual income. 19 of 39 Medical Dental Vision Other Office visits Fillings Exams Counseling Diagnostic testing Cleanings Glasses Cessation programs Surgical procedures Braces Contact lenses COVID-19 tests Over-the-counter medications Artificial teeth Corrective surgery Face masks Prescriptions Hand sanitizer and sanitizing wipes Before You Go How You Pay for Care Special Programs and Services Learn More Simplify Your Health Care Payments with Fidelity Track and Pay You can manage your HSA Plan and Fidelity HSA expenses, payments, claims, and receipts in one place with Fidelity Track and Pay: * Track HSA balance and health expenses * View health care claims * Pay bills with your Fidelity HSA * Upload receipts and manage them from a central location Go to Fidelity.com/trackandpay.
20 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Your HSA in Action: How It Works Let’s look at several examples to see the HSA Plan in action. DEVON ASKS: How does the HSA plan work when I go to the doctor for a physical and take a maintenance medication? • D evon has Associate coverage. The HSA Plan covers preventive care (like annual physicals) at 100% and has an in-network deductible of $2,000. • T he cost of his routine physical exam and other preventive care is 100% covered since he uses a doctor in the network. • D evon’s doctor has prescribed a medication in the Brand Preferred tier that Devon takes on an ongoing basis. Each calendar year, he is responsible for paying for his prescriptions and other in-network qualified medical care until he has paid $2,000—the amount of his deductible. • A fter that, he is responsible for paying 20% (min $30, max $90) of the cost until he reaches his plan’s out-of-pocket maximum of $6,000. * Plan covers preventive care 100%. The plan’s negotiated rates with Devon’s doctor apply. Devon Opened an HSA • C ompared with the Kaiser plan he participated in last year, Devon saves almost $60 in premiums from his weekly paycheck by participating in the HSA Plan. He reasons that the money he is saving on premiums would be better off in an HSA, so he contributes $60 from each paycheck for a total of $3,120 into his HSA for the year. • H is federal tax savings from his pre-tax HSA contributions are almost $750 (assuming he is in the 24% federal tax bracket). Plus, he saves 7.65% on Social Security and Medicare (FICA) taxes.* • E ven if he uses the money in his HSA to reimburse himself for the entire $720, he has still saved almost $750 in federal taxes alone, AND at year-end, he has $1,880 left in his HSA as a basis for future savings or to help pay for medical expenses the following year. * Please see www.irs.gov or Bankrate to determine your federal tax bracket. Then, go to an online HSA Savings Calculator to determine how much you can save. Potential savings on state personal income tax can be difficult to determine. State tax brackets vary greatly, and some states have chosen to tax HSA contributions. Talk to your financial advisor or consult your state department of revenue for more information. Expense Charge What the Plan Pays What Devon Pays Annual physical exam $345 $295* $0 Medication total calendar year $720 $0 $720 TOTALS $1,065 $295 $720
21 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Your HSA in Action: How It Works (continued) SALENA ASKS: How do I use my HSA for a visit to my doctor for strep throat? • S alena gives her medical ID card to the office personnel to make sure they know she is enrolled in the HSA Plan. • T he doctor determines that Salena has strep throat and prescribes a generic antibiotic. • S alena takes the prescription to her pharmacy and shows her MedImpact card to the pharmacist. • S he pays a $10 copay for the generic antibiotic using her HSA debit card. • A fter her appointment, the doctor’s office submits the claim to Blue Cross of Idaho to find out the amount Salena will need to pay. Blue Cross of Idaho will pay the doctor according to negotiated rates. • B lue Cross of Idaho sends Salena a statement or Explanation of Benefits (EOB) indicating the amount due to her doctor and detailing her deductible and other information. • S alena can use funds in her HSA to pay the bill, or she can choose to pay another way and save her HSA funds for future qualified expenses. • S alena decides to use her HSA funds. She uses Fidelity online bill pay to pay her doctor. SALENA ASKS: What happens if I do not have funds available in my HSA to pay for my claims? • I f her HSA is open, Salena can pay for her claims out-of-pocket now and reimburse herself later when there are adequate funds in the account. • S alena can increase her HSA contributions or make a lump-sum deposit with her next paycheck or directly through Fidelity to cover the cost of the claim. HECTOR ASKS: How does funding an HSA save on taxes? • Hector has family coverage with the HSA Plan. • H is total HSA pre-tax contribution for the year is $5,550. Every weekly paycheck, he contributes $106.73 to his HSA. • H ector’s federal tax bracket is 32%. Hector lives in California, where HSA contributions are taxed, so he does not save on state personal income tax.** • H is income tax savings on contributions this year are $5,550 x 0.32 = $1,554. ** Would you like to see how much you can save? Go to www.irs.gov or Bankrate to determine your federal tax bracket. Then, go to an online HSA Savings Calculator to determine how much you can save. Potential savings on state personal income tax can be difficult to determine. State tax brackets vary greatly, and some states have chosen to tax HSA contributions. Talk to your financial advisor or consult your state department of revenue for more information.
22 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Changing Your HSA Contribution Amount 1 Sign in to myACI.albertsons.com with your Employee Number and Password. 2 From the Me page, click on the Benefits tile. 3 Click on Report a Life Event or Update HSA Contribution Amount. 4 Under Select a Life Event, choose HSA Contribution Change and enter the date you want to change your HSA contribution amount. 5 At the top of the page, click Continue. 6 When the Confirmation pop-up appears, click OK. 7 Verify the HSA contribution amount is correct and click Continue at the top of the page. 8 Click Submit at the top of the page to finalize your new HSA contribution amount. 9 Your HSA contribution change has been accepted when you see the Confirmation page. 9 3 4 5
23 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Special Programs and Services As a participant in the HSA Plan, you also have access to several valuable programs and services to help you take care of your health and well-being.
24 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Teladoc Health Telemedicine Teladoc Health is the telemedicine provider for participants in the HSA Plan. With Teladoc Health, you can connect to a doctor in minutes via phone or video consultation while traveling or at home, day or night. Teladoc Health doctors can resolve many of your non-emergency medical issues and can also send prescriptions to your nearest pharmacy if needed. They treat a wide range of conditions, including: • General medical: flu, sinus infections, bronchitis, allergies, sore throats, coughs, COVID-19 and more • Dermatology: eczema, acne, psoriasis, skin infections, rashes, moles, skin spots and more • Mental health: stress, anxiety, depression, trauma, burnout, grief counseling and more • Nutrition: weight management, digestive issues, food allergies, custom meal planning and more Your Share of the Cost for Telemedicine You pay the full cost of the visit before you meet your deductible, then, a $20 copay per visit after you meet the deductible. The full cost of each type of visit is listed below. Why Try Virtual Care? • No “regular” office hours: Talk to a doctor 24/7 by phone or video at home, work or on the go. • No waiting rooms: Skip the trip to urgent care or the emergency room for minor medical issues. • No hassle: Experience simple, convenient and effective virtual care. Get Started with Teladoc Health You have three ways to set up a Teladoc Health account: 1. Go to teladochealth.com 2. Download the Teladoc Health app from the App Store or Google Play 3. Call 800-TELADOC (835-2362) Visit type Cost General medicine visit $57 per visit Dermatology visit $89 per visit Nutrition visit $61 per visit Initial mental health consult with MD $245 per visit Subsequent mental health consult or follow-up with MD $109 per visit Follow-up visit with mental health therapist $99 per visit
25 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Teladoc Health Mental Health Teladoc Health Mental Health is a flexible digital program with mental health tips and tools to strengthen your emotional health on your terms. Get support for anxiety, depression, stress and managing life events through a range of guided programs and interactive content available 24/7 on the Teladoc Health website and app. It’s completely free — you don’t pay anything to access Teladoc Health Mental Health resources. Teladoc Health Mental Health is available to all associates eligible for company health plans, including the HSA Plan. Get Started with Teladoc Health Mental Health When you access your account for the first time, you will be guided to activate your Teladoc Health account. If you are new to Teladoc Health Mental Health, start by creating your Teladoc Health account. You’ll then get a chance to complete your wellness assessment. You can access your account online at www.teladochealth.com or on the Teladoc Health app (from the App Store or Google Play by selecting the Mental Health tile). Need help? Call Teladoc Health at 800-835-2362. For More Information • Download a Teladoc Health flyer. • Download a Teladoc Health Mental Health FAQs. • Read a Teladoc Health Mental Health overview on myACI benefits.
26 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More 2nd.MD AccessHope With 2nd.MD, you and your covered family members have free access to expert medical advice and second opinions from some of the country’s leading medical providers. When you’re facing a medical decision, 2nd.MD can help you receive the right diagnosis and the right course of treatment at no cost to you. 2nd.MD can also help you find high-quality in-network providers in your area. 2nd.MD services include: • Intake to gather your needs and preferences • Rigorous provider evaluation based on clinical data • Validation of insurance acceptance and accepting new patients • Matching with top 25% of condition-specific providers • Transfer of medical records and appointment availability AccessHope provides confidential, leading-edge cancer expertise at no cost. If you or an eligible family member (spouse/domestic partner, children (under and over age 26), parents, parents-in-law, grandparents, grandparents-in-law and siblings) is diagnosed with cancer, AccessHope connects your local oncologist to specialized expertise from worldrenowned National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers including: • City of Hope • Dana-Farber Cancer Institute • E mory Healthcare and Winship Cancer Institute of Emory University • Fred Hutchinson Cancer Center • J ohns Hopkins Medicine and Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins • N orthwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University • U T Southwestern Medical Center and Harold C. Simmons Comprehensive Cancer Center You also have access to compassionate oncology nurses who offer information, empowerment and support when it is most needed. For a comparison and summary of the benefits under 2nd.MD and AccessHope, please see next page. Get Started with 2nd.MD • Call 866-841-2575 • Visit www.2nd.md/albertsons • Download the 2nd.MD app on the App Store or Google Play • Download a 2nd.MD flyer Get Started with AccessHope • Call 844-710-1692 • Visit http://www.myaccesshope.org/albertsons
27 of 39 2nd.MD and AccessHope Benefits At-a-Glance 2nd.MD AccessHope Cost No cost to you No cost to you Description Get an expert second opinion on any medical diagnosis or treatment plan. 2nd. MD can also help you find specialists and get expert answers to your questions. Get leading-edge cancer expertise from AccessHope when you or a family member is diagnosed with cancer at no cost to you. Reason to Contact • New diagnosis other than cancer-related • Possible surgery • Change in medication • Chronic condition • New cancer diagnosis • Expert opinion on treatment options • Dealing with emotional impact • Helping family members cope Covered Conditions • Pending surgery • GI disorders • Musculoskeletal pain • Immunological disorders • Joint pain • Behavioral health concerns • Neurological disorders • Infertility and pregnancy concerns • Vascular disease • Genetic disorders Cancer – no matter where you are in your cancer journey, and whether you’ve receved a cancer diagnosis or are caring for someone who has. Services Provided For non-cancer-related services, 2nd.MD takes care of: • Collecting records • Recommending specialists • Scheduling a consult • Specialist consult • Coordinating follow-up needs with other providers and services available to you Expert Second Opinion Service 2nd.MD offers expert-led education and guidance on any major medical decisions you and your family may face. 2nd.MD helps you gain medical reassurance by connecting you with an expert who can help you with the following: • Pair you with a highly-skilled, experienced nurse who can help you understand your medical situation, review important questions to ask your doctor and help you navigate the healthcare system. • Connect virtually with a doctor who specializes in your specific condition. They will review your medical records and have a detailed conversation with you so you can gain confidence in your diagnosis and treatment plan. AccessHope connects you and your local treating oncologist to specialized experts at world-renowned National Cancer Institute (NCI)-designated comprehensive cancer centers. AccessHope Programs Cancer Support Team. Connect with an experienced, compassionate oncology nurse to discuss tips on preparing for doctor appointments, treatment information, side effect management or emotional support. Expert Advisory Review. Request that an AccessHope medical expert review your case. AccessHope will collect the relevant medical records and provide recommendations on your treatment plan based on groundbreaking insights and leading discoveries for your type of cancer. Your community doctor continues to determine your treatment plan with you, while AccessHope’s experts send recommendations, such as clinical trials and targeted therapies. Contact Information Website: www.2nd.md/albertsons To register, fill in the information under “Get Started!” Telephone: 866-841-2575 Website: http://www.myaccesshope.org/albertsons Telephone: 844-710-1692 Before You Go How You Pay for Care Special Programs and Services Learn More
28 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Transcarent Surgery Care Transcarent Required for Musculoskeletal and Bariatric Surgery Blue Cross of Idaho members are required to use Transcarent for certain bariatric, spine, knee, hip and shoulder surgeries.* When you use Transcarent, you will pay $0 out of pocket after you meet your deductible. You will also receive expert guidance and end-to-end support throughout surgery and recovery. For details, visit https://myaci-benefits.com/health/transcarent/. Take Advantage of Transcarent Benefits for Other Covered Conditions You can also take advantage of the Transcarent benefits for other covered conditions and services. Using Transcarent’s top-rated facilities for non-emergency surgeries will save money while you receive expert-led medical care. In addition to covering the cost of surgery, travel benefits for you and a companion may be available when you need to travel more than 100 miles for care. * Certain spine, knee, hip, shoulder, or bariatric surgeries may only be covered when accessed through Transcarent. Some exceptions apply for members in Boise, ID and Lubbock TX where we are still developing our best-in-class provider network. If you have questions, please contact a Transcarent Care Coordinator. If you do not schedule your surgery with Transcarent (or obtain a waiver for members in Boise, ID or Lubbock, TX), your medical plan will not cover the cost of your surgery. Transcarent is your dedicated partner for spine, knee, hip, shoulder and bariatric surgeries. Let Transcarent take care of the details and get you the results you want — all at little-to-no-cost to you. Transcarent Surgery Care At-a-Glance Covered Conditions/ Services • Certain cancerrelated surgeries • Cardiac care • Vascular • Colonoscopies and endoscopies • Orthopedic and spine surgeries not under the “required use” program • General • Women’s health (gynecological) • Neurologic Plan Pays 100%* Travel Benefit Travel benefits for you and a companion are provided if you are required to travel more than 100 miles from your home. Travel benefits include reimbursements for airfare, hotel and daily meal allowance. Contact Information Contact a Care Coordinator at 888-387-3912 or send an email to surgerycare@transcarent.com. * You pay nothing out-of-pocket after you meet your deductible.
29 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Blue Cross of Idaho Programs Care Management If you are dealing with multiple or complex health problems, Care Management (CM) can help you better understand your conditions, teach you how to take an active role in your health and help with navigating any obstacles you run into. Through this program, you’ll work directly with a care manager who will create a personalized care plan. You also get educational materials and resource support. CM can help you understand your health and make changes that can help you reach your best health. The program offers extra help to members dealing with multiple or complex health conditions like serious trauma, transplants, spinal injuries, cancer, behavioral health, AIDS or multiple chronic illnesses. The program includes healthcare planning, care coordination among your providers, advocacy and more. CM is a voluntary program included with your BCI medical coverage at no added cost to you. Care Management Approach • C are management is a continuous care approach that supports members before, during and after a clinical event. • I t helps members navigate a complicated healthcare system to make sure you get the services you need. • C are managers work with healthcare providers to coordinate care for optimal health outcomes. • C are managers educate members and their support network on their specific condition(s), treatment and resources available. To learn more about the programs, call toll-free at 800-627-6655. You can also email caremanagement@bcidaho.com.
30 of 39 Before You Go How You Pay for Care Special Programs and Services Learn More Blue Cross of Idaho Programs (continued) SmartShopper SmartShopper lets you shop for care and save on out-of-pocket costs when you choose an affordable, effective location and get rewarded for being a smart shopper. Download a SmartShopper brochure How It Works • Y our doctor orders a procedure or test, or you’re due for a preventive screening. • S hop for care using the SmartShopper Personal Assistant Team or search online. • Go to your appointment for your procedure, test or screening. • G et a cash reward in the mail in 4 to 6 weeks. The amount of the cash reward is based on affordability of the procedure at the selected facility. Get Started Call 866-507-3528 to speak with a SmartShopper Personal Assistant; or visit www.bcidaho.com and do an online search: • Select Find a Doctor. • L og in to your account and select the person on your plan who needs care. • Search for care by selecting Browse by Category. • Y ou will be taken to a page that identifies if the procedure is eligible for SmartShopper. • Select Next Page. Your search results will show you: • Facility name, location, contact information and a link to get directions. • A star rating and a link to facility reviews. • Your estimated cost of care. • Your SmartShopper cash reward amount, if eligible.* * Keep in mind that not all facilities are eligible to offer a cash reward amount. Those that are eligible may display different cash reward amounts. These cash reward amounts are based on how affordable a procedure is at a given facility.
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