and-health-reimbursement-arrangements-hra. The State of Washington’s contributions apply to the limits, as does the SmartHealth wellness incentive (see page 28). You may use your HSA to pay for member cost-sharing and other qualified medical expenses as described in Internal Revenue Code (IRC) 223(d)(2), including expenses not normally covered by the plan. You may use HSA funds to pay for expenses for your spouse or tax dependents, even if they are not covered by the plan. The IRS determines which services are eligible for reimbursement through an HSA, and who may pay for services using HSA funds. For details on how to use your HSA, including a list of items and services that you may pay for with your HSA funds, visit the HealthEquity website or contact HealthEquity (see Directory for link and contact information). If you earned the SmartHealth wellness incentive Eligible subscribers can qualify for a one-time $125 into their HSA (if enrolled in a consumer-directed health plan in 2024). If you qualified in 2023 and you are still eligible to participate in the wellness incentive program, the incentive is distributed in January 2024. More details on eligibility and program requirements are on HCA's SmartHealth webpage at hca.wa.gov/pebb-smarthealth. How to pay using your HSA After a claim is processed, you may sign in to your HealthEquity HSA to view your medical claims. However, you will not be able to view your pharmacy claims. You may pay for qualified medical expenses (see the definition of “Qualified medical expense”) and qualified prescription drug expenses by: • Using your HealthEquity debit card at the time of service. • Logging in to your HSA and designating payment to be sent by HealthEquity directly to the provider. However, this option is not available for pharmacy claims. Note: You may make a partial payment using this method. • Logging in to your HSA and paying yourself back for a qualified medical expense and a qualified prescription drug expense you paid using non-HSA funds. For example, if you paid cash at your provider’s office for qualified medical expenses, you may reimburse yourself from your HSA. Reminder: Pharmacy claims will not be displayed. Out-of-pocket limit The out-of-pocket limit is the most you pay during a calendar year for covered services from preferred providers. The out-of-pocket limit is combined for medical and prescription drugs. After you meet your out-of-pocket limit for the year, the plan pays for covered services by preferred providers at 100 percent of the allowed amount. The plan will not pay more than the allowed amount. Expenses are counted from January 1, 2024, or your first day of enrollment (whichever is later) through December 31, 2024, or your last day of enrollment (whichever is earlier). Your out-of-pocket limit depends on the number of persons enrolled in the plan: • Subscriber only (one member) enrolled: $4,200 • Subscriber plus one or more dependents (two or more members enrolled): $8,400. Once a member meets $7,000 in covered out-of-pocket expenses annually, the plan will pay for covered services at 100 percent for that member. What counts toward this limit • Coinsurance for covered prescription drugs paid by the member directly or paid on behalf of the member by another person including payments made through a manufacturer drug coupon or other manufacturer discount. 28 2024 UMP CDHP (PEBB) Certificate of Coverage