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fl,... <br />~~ <br />'~ <br />• Home modification to accommodate <br />handicapped person (as per IRS pub. 502) <br />Q Incontinence supplies <br />• Insect bite/sting medicine <br />• Insurance premiums for medical, <br />dental or long-term care <br />• Laboratory fees <br />• Laxatives <br />• Lip-reading lessons <br />• Lodging for medical care ($50 per night <br />per person up to $100 per night) <br />© Massage therapy if accompanied <br />by doctor's prescription indicating <br />length of time needed and number of <br />treatments needed -updated annually <br />• Medical supplies <br />• Medications which require a prescription <br />to be purchased <br />• Menstrual pain relievers <br />• Mental institution care <br />(mentally ill person unsafe when left alone) <br />I Mentally handicapped, special home for <br />~I Motion sickness medicine <br />~! Muscle/joint pain relievers (except holistic <br />or dietary supplements) <br />', Q Nasal sinus sprays <br />• Nicotine patches, gum, lozenges <br />• Nurses' expenses and board <br />• Nursing care <br />• Nursing home (if for medical reasons) <br />Q Obstetrical expenses <br />• Operations and related treatment <br />(except cosmetic) <br />• Oral wounds (cold sores) <br />• Organ donation, organ transplants <br />• Orthopedic shoes, excess of costs over <br />normal shoes <br />• Oxygen equipment <br />Q Pain relievers <br />• Pedialyte (dehydration) <br />• Pregnancy test kits <br />• Prenatal vitamins (prescribed) <br />If the participant has no spouse or dependents, <br />the designated beneficiary on their account <br />will receive a lump sum life insurance benefit. <br />The amount of the life insurance benefit is <br />based on the HCSP account balance upon the <br />participant's death. <br />Less than $500 $0 <br />$500 - $2,499 $2;500 <br />$2,500 - $4,999 $5,000 <br />$5,000 -'.$7,499 $7,500 <br />$7,500 - $9,999 $10,000 <br />$10,000 - $14,999 $15,000 <br />$15,000 - $19,999 $20,000 <br />$20,000 - $24,999 $25;000 <br />$25,000 - $29,999 $30,000 <br />$30,000 -$34,999 $35;000 <br />$35,000 - $39,999 $40,000 <br />$40:;000 - $44,999 $45,000 <br />$45,000 - $49,999 $50,000 <br />$50,000 or:more $50;000, <br />The proposed tier schedule shown above is subject <br />to change. <br />How does my employer benefit? <br />The Health Care Savings Plan allows your <br />employer an opportunity to offer a benefit that <br />you can use to cover the rising cost of health <br />care. Employers are not required to pay FICA <br />(7.65%) taxes on amounts contributed to this` <br />plan. There areno employer:participation fees. <br />N <br />;r•, <br />~~, <br />i <br />.~~ , ;L~ `~'~ ~ <br />11 HCSP 1-800-657-5757 • ~~1~296-2761 www.msrs.state.mn.us • fax 651-297-5238 ~ <br />