2013 2014 Health Savings Account

Eligibility Associates who are scheduled to work at least 30 hours per week and have also attained 60 days of continuous service are eligible to participate in the program described below. The effective date of participation will be the 1st of the month following attainment of 60 days of continuous service. Associates scheduled to work less than 30 hours per week and Temporary Associates are ineligible to participate in Mattress Firm benefit plans. Dependents Eligible dependents can enroll in Mattress Firms benefits plans; however, supporting documentation will be required to validate eligibility. Please contact the Benefits Department to determine the required supporting documentation. An eligible dependent includes: 1. 2. 3. 4. Spouse (not fianc, but your legal spouse as determined by applicable law) Common Law Spouse Legal Dependent An Associates child up to age 26 (birth, adoption, or stepchild) Qualified Medical Child Support Order

Health Savings Account (HSA) The HSA is a tax advantaged account designed to help you save for current and future health care expenses. HSA contributions will be deducted from your pay, before taxes, to pay for qualified medical expenses. Balances roll over from year to year and the account is portable, which means it stays with you if you change benefit plans or employers. For more details on managing your HSA account and to find additional HSA information visit HSA Enrollment Website . Plan Provisions Must be enrolled in the High Deductible Health Plan (HDHP) to use HSA $3,250 maximum contributions for Associate only $6,450 maximum for family Catch-up provision to contribute an additional $1,000 to your HSA for Associates age 55 or older Contribution limits are determined every year by the IRS Not available to Associates enrolled in the Choice Plus Plan Debit MasterCard issued to member for healthcare expenses On a quarterly basis, Mattress Firm will match a portion of the Associates contributions to their HSA. The following table reflects the annual maximum contributions for matching purposes

Health Savings Account Annual Contributions (Maximum Contributions by Mattress Firm for Associates Participating in the Medical High Deductible Plan)
Associate Only Up to $240 Associate and Spouse Up to $360 Associate and Child(ren) Up to $360 Associate and Family Up to $480

Information contained in this document are summarizations and not intended to replace the full details regarding eligibility, covered expenses, exclusions, limitations, definitions and other provisions of each plan contained in legal documents, handbooks and group contracts. Legal documents shall govern any differences.