Health savings account (HSA) and Flexible spending account ...

1 Health savings account (HSA). and Flexible spending account (FSA) Disclosures HSA Enrollment 1. If you enroll in Option1 or Option 2 of the MassMutual high deductible Health plan (HDHP), a Cigna Choice Fund HSA will be automatically established for you at HSA Bank. 2. If you enroll in Option 1 or Option 2 and do not wish to have a Cigna Choice Fund HSA at HSA Bank, you must cancel the HSA automatically established for you at HSA Bank. 3. If you choose not to have a MassMutual-facilitated Cigna Choice Fund HSA, eligible employees will forfeit any wellness-incentive dollars payable under the Live Healthy, Live Well program. 4. MassMutual will not remit HSA contributions to any HSA other than the MassMutual-facilitated Cigna Choice Fund HSA, which means contributions to other HSAs cannot be made from your pay on a pre-tax basis.

2 HSAs and FSAs 5. MassMutual offers a Health care Flexible spending account (FSA) for the reimbursement of eligible Health expenses. There are two options under the Health care FSA: limited-use and full-use. A limited-use Health -care FSA allows for the reimbursement of qualified dental and vision expenses only and is compatible with HDHP Health coverage and HSAs. A full-use Health -care FSA allows for the reimbursement of qualified medical, prescription, dental and vision expenses and is compatible with Health coverage other than HDHPs. It can also be used by those who are enrolled in a HDHP while receiving Medicare and/or Veterans Affairs benefits. See Medicare and Veterans Affairs Benefits section below. Medicare and Veterans Affairs Benefits 6.

3 Federal tax rules do not allow you to contribute to an HSA if you're enrolled in Medicare. 2017 Massachusetts Mutual Life Insurance Company (MassMutual), Springfield, MA 01111-0001. All rights reserved. HSAFSA 817 Page 1 of 3. 7. If you are receiving VA benefits, federal tax rules ONLY allow you to contribute to an HSA if the VA benefits you've received within the last three months are limited to dental, vision, preventive care, or benefits/services provided in connection with a service-related disability. 8. If you're an employee enrolled in a MassMutual medical option and are not eligible to contribute to an HSA due to Medicare enrollment or use of VA. benefits, any Live Healthy, Live Well wellness incentive dollars that you earn will be included in your pay and treated as taxable income.

4 9. If you're enrolled in a MassMutual medical option and are ineligible to contribute to an HSA due to Medicare enrollment, you are eligible for a full-use Health care FSA. 10. If you receive VA benefits, you have the choice of electing either a full-use or limited-use FSA, but in making that choice, you should be mindful of the impact of the type of FSA you elect on your ability to make HSA contributions. Contributions and Withdrawals 11. You can use your HSA balance to pay for your own qualified Health expenses, or those of your legal spouse and/or qualified, tax-dependent domestic partner or children, as long as the expenses are not reimbursable elsewhere or under another plan. Consult your tax advisor for more information. 12. You cannot submit a claim for reimbursement to both your limited-use Health care FSA and your HSA for the same qualified expense.

5 13. It is solely your responsibility to monitor the contributions made by you (and by MassMutual (if applicable)) to your Cigna Choice Fund HSA to ensure that they do not exceed legal limits. It is also your responsibility to monitor and document withdrawals from your account to ensure that they do not exceed available funds and that they are qualified within the definitions of the Internal Revenue Code and associated regulations. 14. HSA contributions, earnings and qualified withdrawals are exempt from federal and most state income tax. Certain states, however, do not allow before-tax treatment of HSAs and earned interest. Consult your tax advisor for more information. 15. Save your receipts for your reimbursements from your FSA and/or HSA accounts.

6 You need to be able to substantiate that your expenses are eligible for reimbursement to avoid tax penalties. 16. If you are a participant in a MassMutual-sponsored plan and are stationed outside the United States, it is your responsibility to be aware of, and adhere to, the laws and regulations of the country in which you work and to understand any potential impact regarding taxability of contributions, earnings and withdrawals related to an HSA. 2017 Massachusetts Mutual Life Insurance Company (MassMutual), Springfield, MA 01111-0001. All rights reserved. HSAFSA 817 CRN000000-000000. ERISA Notice 17. MassMutual has limited involvement with the HSA and the Cigna Choice Fund HSA is not a company-sponsored ERISA employee welfare benefit plan.

7 MassMutual facilitates your contributions to the HSA, which is sponsored and operated by Cigna. 18. The Health care FSA, including both the full-use and limited-use options, is a company-sponsored ERISA employee welfare benefit plan. 2017 Massachusetts Mutual Life Insurance Company (MassMutual), Springfield, MA 01111-0001. All rights reserved. HSAFSA 817 CRN000000-000000.