Knowing your

Health Savings
Plan basics

When you enroll in medical coverage, CVS Health® Physical wellness

pays the majority of costs. Second only to payroll, Emotional wellness
medical benefits are the company’s largest budget
Financial wellness
item. Here are basics of our Health Savings Plan (HSP).*

Three HSP options plus an HSA Building blocks of the HSP options
We offer three HSP options: HSP 1, 2 and 3. The IRS • Preventive care (check-ups, immunizations and
allows pairing a high deductible health plan like the HSP screenings) is covered at 100% in-network.
with a tax-advantaged Health Savings Account (HSA). • For non-preventive care and medications, you pay
HSAs help offset your costs and let you contribute a discounted rate out of your pocket or from your
tax‑free dollars. There is no minimum contribution HSA until you reach your annual deductible. The
and you make changes at any time. Plus, CVS Health deductible is combined for medical and prescription
contributes to your HSA each pay period based on your costs. The deductible amount depends on the plan
medical coverage level (annual contribution of $500 for you choose and whether you enroll in individual or
individual or $1,000 for family). Interest grows tax-free, family coverage.
and withdrawals for eligible medical, dental or vision • Once you have paid your annual deductible amount,
expenses also are tax-free. CVS Health begins to share your costs for care —
called coinsurance. CVS Health pays 80% of in-
All HSP options have comprehensive medical and
network costs, and you pay 20%. You can use funds
prescription coverage, and generally cover the same
from your HSA to cover your portion. (Out-of-network
services. The differences are the paycheck contribution
cost-sharing is 50-50.)
(or premium), deductible and out-of-pocket maximum
for each. • The out-of-pocket maximum is like a safety net. It’s the
most you’ll pay out of your pocket for care. Beyond that,
HSP 1 HSP 2 HSP 3 CVS Health pays 100% of eligible in-network expenses
for the rest of the plan year (June 1 through May 31).

All have a Health Savings Account (HSA) How the HSP + HSA work together
In-network
preventive care Plan pays 100%
Same services with comprehensive
medical and prescription coverage
Annual
HSA helps pay deductible You pay
your deductible
Different paycheck contributions, and coinsurance Then plan pays 80%
deductibles and out-of-pocket maximums Coinsurance and you pay 20%
(in-network)
* Mainland U.S. colleagues also can elect coverage in a Hybrid Plan. Unused HSA
Different plans apply in Hawaii and Puerto Rico. See dollars roll over; Out-of-pocket After this, plan pays 100%
BenefitMoments.com. yours when maximum for the rest of the plan year
you leave

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More on the HSA Paying for care and your claims
The money in your HSA — from your own contributions
When at your doctor’s office or the hospital, show your
and the company — is yours to keep, even if you leave
medical ID card and you should not have to pay a copay
CVS Health. Unused funds roll over, even into retirement.
or coinsurance. Instead, the provider submits your claim
Once your account balance reaches $1,000, you can
to your health plan who calculates your share and sends
invest your money in interest-bearing mutual funds,
you an Explanation of Benefits. You’ll then receive a bill
which also earn tax-free interest.
from your provider for payment of your share; CVS Health
HSP highlights pays the rest.

HSP 1 has the highest premiums (paycheck contributions)

but lowest out-of-pocket costs, and HSP 3 is the opposite. Explanation of Benefits
HSP 2 is in the middle. • Medical services provided
HSP 1 HSP 2 HSP 3 • What’s eligible and covered (or if not, why not)
Individual Family Individual Family Individual Family • The amount the plan will pay
Annual $1,600 $3,200 $2,100 $4,200 $3,375 $6,750 • What you owe the provider, including deductible
deductible
and/or coinsurance, or any non‑covered amounts
Out-of- $3,200 $6,400 $4,200 $8,400 $6,750 $13,500
pocket max
Ind. out-of- Not applicable $6,750 $6,750 The experience differs in paying for prescriptions at
pocket max the pharmacy, whether you order by mail or in person.
Premiums Highest Middle Lowest
Because the pharmacy can calculate electronically what
Family deductible and you owe, you pay your share at that time.

out-of-pocket maximum To pay for care, you have choices:

If you cover someone besides yourself, you must satisfy 1. Pay using your Inspira Financial debit card. To
the family deductible before the plan pays coinsurance. use your HSA, present your card at the pharmacy
In HSP 1, you must satisfy the family out-of-pocket or doctor’s office or write your card number on the
maximum before CVS Health pays 100% of eligible payment slip you send to your provider.
expenses for any family member for the rest of the plan
year. In HSP 2 and 3, individuals have a separate out-of- 2. Pay using your own funds. You can reimburse
pocket maximum within family coverage — once one yourself later with funds in your HSA — or some
person meets this individual out-of-pocket maximum, colleagues let their HSA grow for the future.
CVS Health pays 100% of eligible expenses for that If you have any questions about your medical benefits
person for the rest of the plan year. Then, once you meet or need help with a claim, call Aetna One® Advocate at
the family out-of-pocket maximum, CVS Health pays 1-800-558-0860 for concierge-level support.
100% of eligible expenses for all family members for the
rest of the plan year.
Know and use your resources
Prescription drugs BenefitMoments.com
The plan covers generic preventive drugs (as
eligible under IRS rules) and brand insulin at 100%. Aetna One® Advocate: 1-800-558-0860
For non-preventive drugs, once you’ve met the CVS Caremark (Rx): 1-866-284-9226
annual deductible — through any mix of medical and
prescription costs — the plan pays 80%. You pay 20%,
Benefits help: ColleagueZone.CVS.com
up to the out-of-pocket maximum. Be sure to check
or call the HR Service Center at
the Value Formulary, as brand medications that
1‑888‑694‑7287
have a generic alternative typically are not covered.
For specialty drugs, once you’ve met the annual
deductible, the plan pays 100% for covered drugs if you
enroll in the Prudent Rx Copay Optimization Program.*
* For specialty drugs in the PrudentRx program, if you do not enroll, you pay 30% of the discounted cost until you meet the out-of-pocket max.;
for drugs that do not qualify as “essential health benefits” under the ACA, your coinsurance does not count toward your out-of-pocket max., and
30% coinsurance applies after the out-of-pocket max. For specialty drugs not in the PrudentRx program, you pay 100% of the discounted cost
until you meet the deductible; then you pay $100 per prescription until you meet the out-of-pocket max.
This summary provides a brief overview for colleagues regularly scheduled to work 30 or more hours per week, and is for informational purposes
only. Hawaii and Puerto Rico plans differ. If there’s any difference between this and plan documents, official plan documents govern. CVS Health
reserves the right to amend, modify or terminate all or part of its benefit plans at any time. This description isn’t an employment contract or guarantee.
Colleagues may need to meet certain eligibility requirements to participate. Colleague contributions are not used to pay plan expenses for vendors
or other service providers that are subsidiaries of CVS Health, except as may be permitted by ERISA. Union colleagues aren’t covered unless their
collective bargaining agreement specifically provides for a benefit.
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