SUPERVALU: Your Health Savings Account (HSA)

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1 SUPERVALU: Your Health Savings Account (HSA) Frequently Asked Questions 1. What is a Health Savings Account (HSA)? A Health Savings Account (HSA) is a savings account established under the Internal Revenue Code for the purpose of paying qualified medical expenses for individuals, his/her spouse, and/or eligible tax dependents. HSAs work hand in hand with a qualified High Deductible Health Plan (HDHP). A qualified HDHP is a health insurance plan that meets certain IRS regulations. Persons not covered by a qualified HDHP, or enrolled in Medicare, or who are enrolled in another health plan other than a qualified HDHP or listed as a dependent on another person s tax return, are not eligible to establish or contribute to an HSA. SUPERVALU HSA Medical Option meets the definition of a qualified High Deductible Health Plan suitable for funding an HSA Account. 2. What are the financial advantages of an HSA? There are many financial advantages to owning an HSA, including: Employer contributions are excluded from your Federal taxable income and most states taxable income (see note below). Contributions you make pre-tax through payroll deduction are excluded from your Federal taxable income, most states taxable income (see note below), Social Security tax and Medicare tax. Post-tax contributions are tax deductible, even if you don t itemize deductions on Form You may make tax-free withdrawals from your account for qualified medical expenses not covered by the SUPERVALU HSA Medical Option. The interest or other earnings on the assets in the HSA accumulate tax free from Federal taxes and most states taxable income (see note below). If, in the future, you are not covered by a HDHP, you may still make tax-free withdrawals from your account for qualified medical expenses, but you may not contribute additional amounts to the HSA. If you become disabled or reach age 65, withdrawals can be made for non-medical reasons without excise tax penalties, but amounts must be reported as taxable income. Note: Your HSA pre-tax payroll contribution and SUPERVALU s contributions are free from Federal and FICA tax. Contributions are also free from state income taxes except for residents of Alabama, California, New Jersey and Wisconsin. Of course, some states do not tax individual income at all. New Hampshire applies state income tax to interest and dividends earned in HSAs. Since each state may have different laws on taxing HSAs, it is very important that you consult your tax advisor for the most current information on tax treatment of HSAs in the state where you live and work. Also refer to IRS Publication 969, "Health Savings Accounts and Other Tax-Favored Health Plans." 3. What are my obligations as an account holder? Your HSA belongs to you and as such, you re responsible for maintaining the account. Here s what s expected of you as an HSA account holder: Ensure that contributions do not exceed the annual maximum.

2 Ensure that withdrawals for non-qualified expenses are added back to gross income. Keep all records that support withdrawals from your account. Complete the required tax form (Form 8889) and attach it to Form 1040 when filing your income taxes. Ensure that you do not have any medical coverage that will disqualify the HSA (such as, but not limited to, Medicare or a spouse covered by your HSA Medical Option, who also has a general purpose Health Care Reimbursement Account/HCRA or Flexible Spending Account (FSA)). Ensure that you cannot be claimed as a tax dependent of someone else. 4. Can I enroll in the High Deductible Health Plan without opening an HSA with the designated administrator? Yes. SUPERVALU associates may enroll in the HDHP (without HSA) medical option. You are not required to open an HSA with the designated HSA Trustee, SelectAccount. Please note, in order to make pre-tax contributions to an HSA (via payroll deductions), and to receive the SUPERVALU/employer contribution to your HSA, you must open an HSA with SelectAccount. HDHP members will be covered for a percentage of their eligible medical expenses after the $1,200 associate only or $2,400 family unit deductible is satisfied. 5. Will SUPERVALU fund the HSA? Yes. SUPERVALU will contribute up to $450 for associate only coverage and up to $900 for associate + child(ren), associate + spouse, or family coverage levels for associates who open their HSA with the designated administrator, SelectAccount. In addition, SUPERVALU also allows voluntary contributions to your HSA via payroll deduction if your HSA is established at SelectAccount, the designated administrator. You may open an HSA with another administrator, however, SUPERVALU will not contribute to your HSA, nor will you be able to elect pre-tax payroll contributions into your HSA. SUPERVALU's contribution to HSAs is allocated in equal installments throughout the plan year up to the maximum amount indicated for full plan year participants. Partial-year participants will receive a prorated contribution. 6. What are the potential advantages of opening an HSA? You have the security of being covered by a comprehensive plan for high-dollar medical expenses and you control how the money in your HSA is spent. For example, you can manage health care costs and out-of-pocket expenses by deciding where and when to receive health care, as well as whether to accept certain services and medications. Not only do you manage the money in your HSA and the expenses reimbursed from it, but contributions to the HSA are tax-advantaged and belong to you, even if you leave employment. The HSA Medical Option also covers preventive care at 100%, not subject to the deductible, when you use a provider in your network. 7. How do I open an HSA? Opening up an HSA with SelectAccount is part of your enrollment process at SUPERVALU, when you select the HSA Medical Option. If you elect to enroll in SUPERVALU s HDHP you will be asked at that time if you want to also establish an HSA with SelectAccount. If you have questions about how to set up the HSA please contact your HR Shared Services or local HR Manager.

3 8. I do not want to spend my HSA funds now, but would rather save the money for future medical expenses or for medical expenses in my retirement. How can I do this? In order to save and not spend your HSA funds, you do not have to do anything. The contributions that SUPERVALU makes, and the voluntary pre-tax contributions you make will be deposited in your account for you to access any time you need. If you do not want to spend your HSA funds, you can pay for your medical expenses out-of-pocket and save the money in your HSA for future medical expenses. With this option, you will pay out-of-pocket for your medical and pharmacy expenses incurred during the year. Your HSA funds will be available whenever you need them, and can be easily withdrawn at any time. Refer to the next question for your reimbursement options. 9. What are my options for reimbursement out of my HSA? Associates that open an HSA with SelectAccount will receive a welcome packet. SelectAccount is the designated HSA administrator that SUPERVALU uses for the convenience of employer contributions and voluntary payroll-deduction contributions to your HSA. The welcome packet will include information about HSA reimbursement options and the forms necessary to manage your HSA with SelectAccount if you do not have access to online resources. Debit card: When you open an HSA with SelectAccount, SUPERVALU pays for you to have a debit card for your account. A debit card will automatically be sent to you, you simply need to activate it. The debit card provides a convenient way to access your HSA dollars right when you need them, either to pay your provider s invoice or pay for your prescription at the pharmacy, and puts the control of when your account is accessed in your hands. Your HSA debit card works the same as other bank account debit cards, but you will not be able to make ATM cash withdrawal requests. If your HSA does not have enough funds for the entire expense, the charge will not be paid from your account, it will be denied. In this case, you will need to pay for this service in another way, such as out-of-pocket, and submit for reimbursement on-line for the amount you do have in your account. It s important to note if you are using your HSA debit card and later elect to use the "Crossover/Pay-the-Provider" feature (see below), use of your debit card will be discontinued while the "Crossover/Pay-the-Provider" service feature is in force on your account. If you switch to Crossover/Pay-the-Provider" your debit card will be canceled. If you later decide to switch back and request a debit card, your crossover will be discontinued and you will receive a new card. Crossover/Pay-the-Provider: In lieu of a debit card, you also have the option to elect crossover. Automatic medical claims reimbursement, or crossover, enables Blue Cross Blue Shield of Minnesota to electronically submit claims to SelectAccount for reimbursement to you. To elect crossover, simply sign in to mybluecross at bluecrossmn.com/supervalu and select HSA and then Account Options. You will see Medical Crossover. Elect the crossover option. Or, if you do not have internet access, you can also contact member services at (toll free). If you elect crossover, you will also automatically be enrolled in Pay-the-Provider. This means, if SelectAccount administers the HSA and you elect crossover, eligible medical

4 expense reimbursements will be automatically sent to the provider directly from your HSA as long as there is a balance available. Expenses that exceed the HSA balance are pended up to twelve months and reimbursed back as funds become available. When there is still a balance with your provider, additional reimbursements for that claim will be made to you as contributions are received. You will need to pay any balance to your provider. If you want to opt out of crossover/pay-the-provider, contact your member services at (toll free), or go on-line to opt back out. It s important to note that Crossover/Pay-the-Provider" and debit cards don t work at the same time and that this feature, unlike debit cards, is not available for pharmacy purchases. For members who want the option to decide when their account will be accessed we recommend using our debit card and on-line withdrawal option. For members who prefer Crossover/Pay-the-Provider", you will need to appropriately discard your debit card and sign up for that feature. Once you sign up for Crossover/Pay-the-Provider", your debit card will no longer be active. Online: With this option, you simply request a reimbursement/withdrawal in the amount needed from your HSA via your secured web access. Reimbursement will be provided based on the reimbursement method selected after you opened your HSA (either by check or automatic deposit into a checking or savings account). To request a withdrawal, simply sign in to mybluecross at bluecrossmn.com/supervalu. Click on HSA and then select the withdrawals tab. From there you will see an option to request withdrawal. Paper Claims: With this option, you submit all charges for reimbursement yourself on a paper claim form. Reimbursement will be provided by SelectAccount based on the reimbursement method you selected after you opened your HSA (either by check or automatic deposit into a checking or savings account). 10. How does an employee make contributions to an HSA? Associates may make pre-tax, post-tax, or a combination of both types of contributions to their HSA at SelectAccount. SUPERVALU offers the convenience of payroll deduction to make pre-tax contributions to a SelectAccount HSA. Once you have opened an HSA with SelectAccount, you can make pre-tax contributions at Open Enrollment or throughout the year, up to certain limits. Please contact SUPERVALU for any limitations in regard to pre-tax contributions. To make a post-tax payroll contribution into your HSA, you can send SelectAccount a check, or apply online for direct contribution. To apply online for direct contribution, simply sign in to mybluecross at bluecrossmn.com/supervalu. Click on HSA and then select the contributions tab. From there you will see an option to apply for direct contribution. After SelectAccount approves your application, use this form to set up a single or monthly contribution directly from your bank account Total contributions, including those from SUPERVALU, may not exceed $3,100 for associate only coverage or $6,250 for family coverage in Associates who are or will be age 55 by the end of the year, not enrolled in Medicare, and otherwise eligible to participate in an HSA, may make an additional tax-advantaged contribution for 2012 of up to $1,000. You are responsible for managing your maximum contributions.

5 11. What happens if money is left over in the HSA at the end of the year? Unused HSA funds remain in your account and roll over for future use. There are no limits on rollover amounts. Interest is earned on money in the account and, as your balance grows, you become eligible for more investment options. Contributions remain in the account until used. 12. How will 2012 claims be paid when I have an HSA effective January 1, 2012 and a grace period for my existing FSA until March 15, 2012? If you have funds in a general purpose Health Care Reimbursement Account (Flexible Spending Account) on the last day of the calendar year (on 12/31/2011), and you elect to enroll in the HSA Medical Option, you will not be able to make contributions to your HSA; and you will not be able to receive Employer contributions to your HSA for the first three months of The missed employer contributions will not be made up or allocated in this situation. You will be able to contribute to the HSA for the months of April through December If you have funds in a limited purpose Health Care Reimbursement Account, eligible expenses during the grace period (the first 2 ½ months of 2012) do not affect your ability to contribute to the HSA 13. Can an employee over age 65 open an HSA? Yes, as long as the employee is not enrolled in Medicare A or B and is otherwise eligible to establish and contribute to an HSA. 14. What happens to the HSA if I leave SUPERVALU? The HSA is portable and owned by you, even if you leave SUPERVALU. As long as you remain covered by a qualified High Deductible Health Plan, you may continue to contribute to your HSA. You may elect COBRA to continue the HDHP. If you are not covered by a HDHP after you leave SUPERVALU, you may continue to receive reimbursements from your HSA for qualified expenses until the HSA is exhausted, but you cannot contribute more into the HSA. You may also leave funds in the HSA and continue to earn interest on the balance. Associates who leave SUPERVALU and/or discontinue coverage in the HSA Medical Option, will be responsible for their own HSA fees. In addition, if you leave SUPERVALU and/or discontinue coverage in the HSA Medical Option, your administrative fees will be automatically deducted from your SelectAccount HSA. 15. What happens to the HSA if I don t enroll in 2012? You are no longer eligible to make contributions to your HSA if you re not enrolled in a qualified High Deductible Health Plan. You can, however, continue to receive reimbursements from your HSA for qualified expenses until the HSA funds are exhausted. You may also leave funds in the HSA and continue to earn interest on the balance. SUPERVALU will no longer pay the SelectAccount HSA administrative fees when you are no longer enrolled in the HSA Medical Option. 16. What premiums can be paid from an HSA? Qualified premiums include: COBRA, Health insurance after your reach age 65 (other than Medicare supplement), Qualified long term care insurance, Health insurance premiums while receiving unemployment compensation, and Premiums for employer-sponsored retiree medical plans for account holders 65 or older.

6 17. Are claims that I incurred prior to setting up my HSA eligible for reimbursement? No, claims incurred prior to the date your HSA was established are not considered qualified medical expenses. Eligible expenses must be incurred on or after the effective date of the HSA. This means the HSA must be established before any expenses may be reimbursed from it. Your HSA is considered established when it is opened and has at least one cent deposited. 18. What happens to an HSA if the account holder dies? As an account holder, you may designate a beneficiary when you open your HSA and you may change your beneficiary designation in writing at any time. If a spouse is the designated beneficiary of an HSA, the account will be treated as the spouse s HSA after the death. If the spouse is not the designated beneficiary of the HSA on the date of death, the account stops being an HSA and the fair market value of the HSA becomes taxable to the designated beneficiary. If there is no designated beneficiary, the fair market value of the account will be included in the account holder s final income tax return and estate tax return. 19. What happens if contributions exceed the annual limit? Generally, you must pay a 6 percent excise tax on contributions made to an HSA that are greater than the annual limit. (See IRS Form 5329 to determine this tax.) If excess contributions have been made, you won t pay the excise tax on that excess amount if you withdraw the excess contributions by the due date, including extensions, of your tax return, and if you withdraw any income earned on the withdrawn contributions, and include the earnings in other income on your tax return for the year. Consult your tax advisor. 20. Can I change my pre-tax HSA contributions during the year? Yes, because the eligibility requirements and contribution limits for HSAs are determined on a month-by-month basis, rather than on an annual basis. If you elect to make HSA contributions under a cafeteria plan, you can start or stop the election or increase or decrease the amount on a monthly basis, as long as the change is effective prospectively (i.e., after the request for the change is received). 21. Can I transfer funds from an existing account (MSA or HSA) to my SelectAccount HSA? Yes. If you would like to transfer an existing HSA or MSA balance to SelectAccount, SelectAccount will facilitate the movement of the assets from the previous account directly to the new account. You can do this by completing the transfer form included in your welcome packet. 22. Can I rollover funds from an existing account (MSA or HSA) to my SelectAccount HSA? Yes. If you would like to rollover your existing HSA or MSA to SelectAccount, the assets in that account will be distributed to you, and you will need to deposit the funds into your SelectAccount HSA. Under a rollover option, you must pay the amount into the new account with SelectAccount no later than the 60th day after the day the withdrawal was received from the previous custodian in order to avoid tax penalties.

7 23. How is interest credited to the account? SelectAccount will credit interest monthly on the average daily balance for the month in your HSA. SelectAccount reserves the right to declare a different rate of interest at any time. SelectAccount does not pay interest on funds that are transferred to investment accounts. 24. I have a major medical expense in the first few months of the year. Can I contribute a lump sum into my HSA? If you have an upcoming major medical expense and want to fund your HSA with the anticipated out-of-pocket costs, you can submit a check to SelectAccount for deposit into your HSA. Please make sure you don t exceed the maximum HSA contribution allowed by the IRS. Note: by writing a check, you will have to manually submit this amount individually as an aftertax deduction for tax purposes. Contributions made after-tax directly to your HSA are eligible for a tax deduction on your income taxes, even if you do not itemize deductions. Consult your tax advisor. Please note: If you make a lump-sum deposit directly to your HSA, and you are also making pre-tax contributions to your HSA via payroll deductions or receiving the SUPERVALU/Employer contributions to your HSA, you will need to ensure that your do not exceed the IRS limits for maximum HSA contributions. You are responsible for your HSA maximum. Consult IRS Publication 969: Health Savings Accounts. Consult your tax advisor. 25. Where can I go to learn more about my HSA with SelectAccount? Visit the Blue Cross and Blue Shield of Minnesota website at bluecrossmn.com/supervalu. To logon, use your member ID. You will not need to type in the 3-letters prior to the member ID, just start with the XZ and then the numbers that follow. 26. Can I use my HSA funds to pay for qualified medical expenses for dependents if they are not currently covered under the HSA Medical Option? Yes. You can use your HSA to pay for qualified medical expenses incurred by your spouse or your tax dependents on a tax-free basis, regardless of whether they are covered under your health care coverage. MII LifeInc., d.b.a. SelectAccount, is an independent company providing account administration services.