HSAs the American Fidelity Way:

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1 Health Ser vices Admiistratio, LLC

2 HSAs the America Fidelity Way: Kowledge, Experiece, Commitmet With over 30 years experiece i providig pre-tax services, America Fidelity is a pioeer i Sectio 125 flexible beefit plas. Puttig our kowledge ad kowhow to work for you is what we do best. Perhaps most importat, Health Services Admiistratio, LLC ( AF Health Services Admiistratio ) is a idepedet HSA admiistrator. No matter who your medical provider may be, we are here to help. We hadle your HSA admiistratio eeds while you make medical pla decisios based o your best iterests. The power is yours, the work is ours. The bottom lie whe it comes to you ad your family is that you would do almost aythig to guaratee their health ad safety. But, these days it seems that the cost of stayig well does ot help maitai a healthy bottom lie for the average household. Especially whe you cosider the risig costs of health care ad the pich of health pla restrictios that makes it harder to get the care you seek. What if there was a way to save for medical expeses eve ito retiremet ad get away from the red tape of traditioal medical plas to gai freedom of choice ad quality protectio? Do t wait for tomorrow, the aswer is here today: Health Savigs Accouts (HSAs). Cosider the advatages this tax-advataged medical savigs optio ca provide you: 1. Ivest i Yourself You ca make cotributios ad get a above-the-lie tax deductio. Balaces roll over from year to year. There is o Use it or Lose it clause. Cotributio dollars are ivested i iterest-bearig accouts. 2. Flexibility HSA dollars ca pay for qualified medical expeses defied by the IRS. Eligible expeses iclude: deductibles, co-paymets, detal ad visio expeses, ad doctor appoitmets that are ot covered by other isurace. You decide how much to put ito your HSA, what medical expeses to pay from the accout, whether to ivest, ad which ivestmets to make. You take part i your health care ad provider decisios while choosig the best way to sped your hard-eared dollars. Use fuds to pay for curret medical expeses or save moey for future eeds. 3. Portability No matter where you go, your accout will follow. Eve if you chage jobs, chage medical coverage, become uemployed, move to aother state, or chage your marital status, your HSA goes with you. You ow it! 4. Tax Savigs The three-tiered tax savigs are hard to beat 1. Tax-free cotributios 2. Tax-free growth 3. Tax-free withdrawals for qualified medical expeses

3 Get to Kow AF Health Services Admiistratio AF Health Services Admiistratio is proud to be a member of the America Fidelity family of compaies. America Fidelity Assurace Compay is a family-owed orgaizatio with a 45-year history of providig our customers with soud fiacial security solutios. We are proud of our associatio with oe of the top-rated isurace compaies i the atio. There is so much to lear about savig today to pay for healthcare tomorrow. With AF Health Services Admiistratio you gai that kowledge ad icrease your power of opportuity by lettig us help you fid the optios that are right for you. Plus, you gai the comfort of doig busiess with a member of the America Fidelity family of compaies. What Makes Us Differet? Idepedece AF Health Services Admiistratio will be your HSA admiistrator o matter which isurace provider you use. Freedom of Choice We kow that you work hard for your moey, ad that is why you should decide the best way to sped it. Whe you are ot tied dow by the restrictios of typical medical coverage ad you decide where the dollars i your accout are best spet, you gai the optio to grow your savigs. Plus, oce your accout balace reaches $2,500, you may choose to ivest your additioal fuds i a strog offerig of mutual fuds that cross all ivestmet risk toleraces. Maitaiig Focus We take a cetralized approach, focusig o all your health savigs eeds from settig up your basic accout to assurig you have the ivestmet optios that will work best for you. Ease of Access These are your fuds, so accessig them should be easy. That s why we offer paymet of qualified expeses through a debit card, olie paymet request submissio ad dowloadable paymet request form. Sice use of HSA fuds are oly available if fuds are i your accout, these withdrawal optios helps you esure that fuds are available ad prevet overdraft charges. Olie Support 24/7 Our olie offerigs make sure you are up-to-date with your accout iformatio, offerig access to: Accout summaries Portfolio allocatio Mutual fud trades Trasactio history Ivestmet Optios IvesTrust serves as our pla custodia. Aother experieced member of the America Fidelity family, IvesTrust specializes i safeguardig your fuds as well ad providig ivestmet expertise. We kow that everyoe is differet, so it oly makes sese that your accout ivestmets match your eeds. Your fuds are ivested i AIM moey markets ad the etire iterest eared is applied to your accout. If you seek higher returs or value security, we do ot charge trasactio fees or broker commissios whe we give you access to ivestmet fud optios that cover the spectrum of ivestmet risks. (Fees associated with certai mutual fuds may be icurred. Review the mutual fuds prospectus for additioal iformatio whe you are ready to ivest.) AF Health Services Admiistratio provides a strog offerig of o load mutual fuds that cross all ivestmet risk toleraces. You pick the mutual fud that best suits your eeds ad risk tolerace from our carefully moitored list. A miimum of at least $2,500 should be maitaied i moey markets before you ivest i the mutual fuds offered. If you eed help explorig the optios, we provide a screeig process to help you select from the premium mutual fud offerigs. Because our idepedece allows us to pick the best mutual fuds, we ca offer the most attractive opportuities ad maitai our focus o fidig the best optios for you. We provide coveiet olie viewig of the prospectus for each mutual fud to help you i your decisio-makig process. Easy Way to Pay We supply a debit card to pay for your qualifyig medical expeses aywhere. Preset your card, select Credit as your paymet optio ad fuds will be deducted directly from your HSA. If your major medical pla discouts services, you should ot use your debit card at the time of service, uless you kow your exact cost. Istead, whe you receive a statemet (EOB) from your health pla provider showig ay discouted rates ad applied isurace paymets, you simply call the provider ad give them your debit card umber at that time. No eed to mess with writig a check, payig for postage or rememberig to mail your paymet. We uderstad Customer Service is importat to you. Our commitmet is to have persoel available to assist you, ot a automated respose. Whether you have questios about your accout or you eed ivestmet assistace, Customer Service is available to assist you at or or by fax at or by ig us at com. Ad of course you have access to your accout iformatio 24/7 via our Web site.

4 LEARN MORE What is a HSA? It Makes Sese for Your Dollars The Tax Advatage Made possible by 2003 legislatio that wet ito effect Jauary 1, 2004, HSAs are tax-favored trust or custodial accouts that ear you iterest. They combie tax-free savigs earmarked for qualified medical expeses with a qualified High Deductible Health Pla (HDHP). How Does It Work? Experiece the moey-savig advatages whether you make a deposit, withdraw fuds to cover qualified expeses, or save uused fuds that rollover each year. HSAs provide a tax advatage across the board. Cotributios HSA Withdrawals A HSA ad a qualified HDHP work as parters to offer Iterest you protectio i time of eed while empowerig you as a coscietious health cosumer. First, moey deposited tax-free ito a HSA is used for qualified medical expeses ot covered by isurace or that fall short of your pla s deductible. Next, the high deductible pla with traditioally lower premiums would kick i to cover ay larger, qualified medical expeses should the eed arise. You gai the power to choose the best way to use the moey typically spet o health isurace aloe ad the potetial to let the accout grow tax-favored util you eed it most. With a HSA you experiece: Tax-Free Cotributios HSA cotributios are 100% tax deductible. A qualified idividual ca make cotributios ad receive a above-the-lie tax deductio, meaig the cotributios reduces the idividual s adjusted gross icome before ay itemized or stadard deductios are cosidered. Idividuals who have cotributios deducted from their paychecks through their employer s sposored Sectio 125 Cafeteria Pla ca take advatage of tax savigs each moth. Tax-Free Growth Iterest ad ivestmet earigs o HSA fuds are geerally tax-free. Tax-Free Withdrawals Withdrawals escape taxatio 100% of premiums goes to the isurace compay More affordable premium meas savigs ca be placed i a HSA - tax free. etirely whe withdraw for qualified medical expeses.

5 Am I Eligible? There are several items to cosider i the establishmet ad cotributio to a HSA. You must be covered uder a qualified high deductible health pla (HDHP) that meets the followig guidelies. Check with your isurace carrier about a qualified HSA Health Pla. Aual Maximum Out-of-Pocket Expeses Self-oly coverage $1,200 $5,950 Family coverage $2,400 $11, /2011 Health Aual Isurace Pla Miimum Deductible (1) Deductible must apply to all medical expeses, icludig prescriptios, except prevetative care. (2) Family coverage = ay coverage other tha self-oly coverage that also covers participat. (3) Miimums ad Maximums are idexed aually. I additio, to be a eligible idividual, you must establish that you are ot: Beig claimed as a depedet o aother perso s tax retur. Covered by ay other health pla that is ot a HDHP. Note: Exceptios apply for certai limited coverage types such as worker s compesatio, liability, property or casualty isurace or isurace for a specified disease or illess that covers a fixed amout per specified period of hospitalizatio. Covered uder ay other type of health beefit that covers some of the medical expeses that are covered by a qualified HDHP Note: You are ot eligible for a HSA if you have a geeral purpose health Flexible Spedig Accout through your employer or your spouse s employer which allows reimbursemet of your medical expeses. However, you ca have a limited purpose FSA which restricts reimbursemets to eligible Visio ad Detal expeses. Erolled i Medicare Note: Eve if you are eligible for Medicare, as log as you are ot erolled i Part A, Part B or Part D, you ca establish ad cotribute to a HSA. Oce erolled i Medicare, you ca o loger make cotributios, however, you ca cotiue to use or save the fuds already accumulated i your HSA.

6 How do cotributios work? You, your family members, ad/or your employer ca make cotributios to your HSA. Uused balaces at the ed of each year carry forward to followig years ad there is o limit o the total accout accumulatio. The followig guidelies apply whe makig cotributios. The maximum aual cotributio you ca make i ay oe tax year is the maximum established by law. Idividual Coverage Family Coverage 2010/2011 $3,050 $6,150 Maximums are idexed aually. If you are at least 55 years of age ad ot curretly participatig i Medicare you ca take advatage of a catch-up cotributio of $1,000 per year. You ca make the maximum cotributio o matter whe you tur 55 i the tax year. If the effective of your HDHP is other tha Jauary 1, you ca make the maximum cotributio allowed by the IRS; however, special guidelies apply. If you cotribute the maximum allowed i ay tax year where the HDHP is i force less tha 12 moths, regulatios require that you remai a qualified idividual for every moth i that tax year followig the effective date of the HDHP plus the etire 12 moths of the followig tax year kow as testig period. If you do ot remai a qualified idividual durig the testig period, the a portio of your cotributios are subject to icome taxes ad a 10% additioal tax pealty. This tax pealty will icrease to 20% begiig Jauary 1, Example: You purchased a HDHP Self-Oly Coverage effective 09/01/10. You ca cotribute the maximum of $3,050 i 2010 eve though your qualified HDHP was ot i effect durig the etire 2010 tax year. You will eed to remai a qualified idividual from 09/01/10 to 12/31/11 to avoid the cotributios from beig subject to icome taxes ad pealties. Let s say you did ot remai a qualified idividual as of 03/01/11, the cotributios attributed to 01/01/10 through 08/31/10 (8/12 of $3,050 or $2,033.33) is subject to icome taxes ad a 10% additioal tax pealty. (20% as of Jauary 1, 2011) The icome taxes ad the 10% additioal tax pealty, (20% begiig Jauary 1, 2011) will ot apply if a idividual becomes disabled or dies durig the testig period. The testig period requiremet also applies to the catch-up cotributio. You ca avoid cotributios beig subject to the testig period requiremets if you pro-rate your cotributios based o the umber of moths you are covered by a qualified HDHP i ay give tax year. To take the example above, a idividual would calculate the maximum cotributio as follows: $3,050 divided by 12 moths = $ x 4 moths of HDHP coverage (09/10/10-12/31/10) = $1,016.66, the maximum cotributio for Att: Sole proprietors, parters or shareholders of Subchapter S Corporatios ca establish ad cotribute to a HSA o a tax advatage basis.

7 How do I use my HSA? Moey from your HSA ca be used to pay for qualified out-of-pocket medical expeses for yourself, your spouse or your tax depedet childre eve if they are ot covered uder a HDHP. Qualified medical expeses, as outlied by the Iteral Reveue Code 213(d), iclude deductibles, hospital care, visio care, doctor visits, prescriptios, detal care, ad over-the-couter medicatio to ame just a few. Begiig Jauary 1, 2011, over the couter drugs, medicies, ad other biologicals will o loger be cosidered a eligible medical expese uless prescribed by a doctor. You ca use the moey from your HSA at ay time oce the HSA is established, for qualified medical expeses icurred after the establishmet of your HSA, ad as log as fuds are available i the accout. Ad eve if you decide ot to make withdrawals from your HSA for qualified medical expeses at the time they are icurred, you ca always make withdrawals for these expeses aytime i the future. For the most part, other health isurace premiums, icludig detal ad visio care premiums, are ot qualified expeses. Exceptios to this rule iclude: Log-term care coverage subject max allowed. Health pla coverage while receivig uemploymet, COBRA cotiuatio coverage, ad For those age 65 or older. ay deductible health isurace*, other tha Medicare supplemetal policy. to *Qualified expeses from a HSA for idividuals erolled i Medicare iclude premiums ad out of pocket expeses for Part A, Part B, Part D, Medicare HMO ad prescriptio drug coverage, but do ot iclude Medigap premiums What are the tax treatmets of a HSA? 1. The fuds withi the HSA belog to you tax-free based o the qualificatios outlied i this the IRS regulatios. 2. As with ay deductio you claim o your icome taxes, keep your receipts for withdrawals you make from your HSA to show moey was withdraw for qualified expeses to avoid additioal taxes ad pealties. 3. Fuds withdraw for ay other reasos are taxable as icome ad subject to a additioal 10% pealty (20% begiig Jauary 1, 2011). After age 65, fuds withdraw are taxable at the ormal rate but o pealty applies. 4. You ca take a above-the-lie tax deductio o your Form 1040 for your cotributios (eve if you do ot otherwise itemize).* If you cotribute to your HSA through your employer s Sectio 125 pla, your cotributios are pre-taxed. *Always check with your tax accoutat or the IRS to esure accuracy.

8 About America Fidelity Assurace Compay: America Fidelity Assurace Compay is a third-geeratio, family-owed orgaizatio providig isurace products ad fiacial services to educatio employees, trade associatio members ad compaies throughout the Uited States ad across the globe. Sice 1982, America Fidelity has bee rated A+ (Superior)1 by A.M. Best Compay oe of the atio s leadig isurace compay ratig services because of America Fidelity s strog fiacial coditio ad operatig performace. Because of America Fidelity s fiscal stregth ad fiacial security, the compay has bee rated A (Excellet)2 with TheStreet.com, Ic (formerly Weiss Ratigs, Ic.). This places America Fidelity o the list of TheStreet.com s Recommeded Compaies, a elite group of life, health ad auity compaies. America Fidelity s ratig represets the top 2.8 percet of isurace compaies. America Fidelity is fouded o ad drive by the priciple of servig our customers ad protectig their ivestmet. We cotiue to grow steadily through calculated growth ad coservative ivestmet practices. 1 Best s Isurace Reports: Life/Health, 2009 Editio, Vol. I, July 15, 2009 (A+ is the 2d out of 16 with 1 beig the highest.) 2 TheStreet.com Ratigs Guide to Life ad Auity Isurers, Witer (A is the 2d out of 16 with 1 beig the highest.) For more iformatio, cosult: SB N. Classe Blvd. Oklahoma City, OK

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