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CIGNA/HAP CHOICE + HSA | and CIGNA/HAP Choice + HSA II High-Deductible Health Plans (HDHP)

Medical Plan Basics – High-Deductible Health Plan with HSA (HDHP + HSA)

There are two CIGNA HDHP + HSA options for you to choose from. The HDHP provides medical coverage with a high deductible, and an HSA helps you pay for your share of the medical expenses you incur. The Company contributes funds to your HSA that can offset your out-of-pocket expenses.

The medical component of the HDHP + HSA plan is similar to the PPO option.

Each year, you’ll pay the full discounted health care costs up to the annual deductible before the plan pays any benefits. The plan’s coinsurance then takes effect, and the plan pays part of your covered medical costs. The amount of the coinsurance depends on whether you use an in-network or out-of-network provider. When your annual out-of-pocket costs reach the set maximum, the plan will pay 100% of your covered costs for the rest of the year.

The HDHP + HSA plans cover the same health services as the PPO plans, including inpatient and outpatient care, doctors’ office visits, emergency care, prescription drugs, mental health and substance abuse care, and foot care. Remember, in-network preventive care is covered at 100% under the high-deductible medical plan.

Health Savings Account (HSA)

The HSA is designed to help you manage your health care costs. If you enroll in the plan, you’ll receive a welcome kit with information about using the HSA. JPMorgan Chase administers the CIGNA/HAP Choice + HSA Plans.

HSA Contributions

Chrysler will make a lump-sum contribution to your HSA, which will be available to you starting in mid-January.

You can also contribute your own money to the HSA. There are two kinds of HSA contributions:
• Regular HSA Contribution—your regular contribution, when added to the Company’s contribution, can’t exceed the IRS allowable maximums as shown above.
• Catch-up HSA Contribution—retirees age 55 or older can make additional catch-up contributions. The 2011 limit for catch-up contributions is $1,000.

HSA contribution limits, determined by the IRS, remain unchanged for 2011.

HSA Contributions Company Contribution Maximum Retiree Contribution Allowable Maximum Contribution
Retiree Only
Retiree + Family

If you choose to contribute to your HSA, you can do so after you enroll in the plan. You’ll receive instructions from JPMorgan Chase. You’re responsible for ensuring that contributions to your HSA don’t exceed the IRS limit during the year. You may have to pay a penalty if they do.

All your HSA contributions and any investment earnings are tax-free, as long as you use them to pay for eligible health care costs. And these funds roll over from year to year.

Your HSA belongs to you. So, if you leave the plan, you can continue to use the money for your health care expenses. In the event of your death, your beneficiary will receive any balance in your account.

Using Your HSA

When you incur an eligible health care expense, you can use money from your HSA to pay all or some of the charge (including your annual deductible). You can use a special HSA debit card, which you’ll receive soon after you enroll, or you can submit a reimbursement request. Any money in your account at year-end will roll over to the next year; you won’t lose it. So, you can leave it in your account to accumulate to pay future expenses.

When your balance reaches $2,000, you can invest the money in your account in one or more of the funds offered by the HSA trustee. You’ll receive information about the investment options after you enroll. And you’ll be able to manage your HSA online, where you can track your HSA balance, file claims, review a list of eligible expenses, and learn more about how your account works. You’ll receive monthly statements that show your fund balance and claims activity. Also, you can call customer service for account information and support.

IRS Guidelines
  • If you take money from your HSA to pay for nonqualified expenses, you’ll pay income taxes on that amount. Effective January 1, 2011, if you’re under age 65, you’ll also pay a 20% penalty.
  • To take advantage of the tax-free benefit, use Form 8889 to claim your HSA contributions when you file your federal income taxes. Consult with your tax advisor for additional details.
  • Visit the IRS Website at for more details (Publications 502 and 969).

Post Age-65 Medical Coverage
When you or a covered dependent reaches age 65, Medicare Parts A and B will provide primary coverage for hospital and medical services, and Medicare Part D is an option for prescription drugs. The three parts of Medicare are shown in the chart below.

Medicare Part Covered Services Your Costs
Part A
Inpatient hospital services, skilled nursing facility services, certain home health services and hospice care
No premium. You’ll pay deductibles and coinsurance
Part B
Doctor services, outpatient hospital services, medical equipment and supplies, and other health care services and supplies
Monthly premium, deductible and coinsurance
Part D
Prescription drugs
Monthly premium, deductible and coinsurance

You or your spouse/domestic partner may purchase coverage to supplement Medicare from individual market health care plans outside of Chrysler when you reach age 65. You’ll receive information about your options approximately 90 days before your 65th birthday.

The Company will establish a Health Care Retirement Account (HRA) to help you pay your premiums and other health care costs at that time. For 2011, post-age-65 retirees are eligible to receive up to $1,920 in medical expense credits if they have 100% age/service credits; spouses and domestic partners are eligible to receive up to $1,750.

Chrysler-provided health care coverage will end on the first day of the month in which you turn age 65. The HRA will be prorated based on the full months remaining in the year.

Phone Numbers

Health Plan Overview

CIGNA/HAP Choice is the administrator of the medical plan and JPMorgan Chase is the administrator of the HSA. CIGNA/HAP Choice is a High Deductible Health Plan (HDHP) coupled with a Health Saving Account (HSA).


To be eligible for an HSA, you must meet several requirements:
  • You must be covered under a high-deductible medical plan.
  • You must be under age 65 and not enrolled in Medicare.
  • You can't be enrolled in any other medical plans, including spousal plans and individual plans. However, your spouse and dependents can have other coverage.
  • You can't be claimed as a dependent on another person's tax return.

Plan Highlights:

Preventive Services Covered at 100% - The CIGNA/HAP Choice + HSA plan encourages healthier lifestyles by covering preventive services at 100% subject to age and frequency guidelines when care is received in-network. Also, certain generic drugs are covered at 100% with no deductible or co-insurance.

Covered Services Applied to Deductible - Prescription drugs costs are applied to the same deductible as medical, unlike PPO plan offerings. Also, all medical services, including hearing, foot care and mental health & substance abuse services and durable medical equipment are subject to deductible and co-insurance up to the out-of-pocket maximum.

Health Plan Resources

Medical Plan Comparison Chart: (2011)
CIGNA/HAP Plan Brochure
Case Management
Preventive Services Guideline
Vision Comparison Chart (2011)
Well Aware Chronic Condition Management

Search for an In-Network Provider:
CIGNA/HAP Open Access Plus Network which incorporates the HAP PPO network
Members: Non-members:

Prescription Drugs

CIGNA is the administrator of the Prescription Drug plan. Mail order prescriptions are available through CIGNA's Tel-Drug.

Phone: 1-800-244-6224
Prescription Drug Cost Guide

For More Information

Phone: 1-800-244-6224

Phone: 1-800-401-4041


Health Savings Account (HSA) Overview

JPMorgan Chase is the administrator of the HSA, an individual investment account to pay for present and future qualified medical expenses with tax-free dollars. An HSA can only be set up in conjunction with a High-Deductible Health Plan (HDHP), such as the CIGNA/HAP Choice Plan. All HSA tax references and certain eligibility requirements are regulated by the IRS.

HSA Plan Highlights:

  • Deposits, earnings and withdrawals for qualified health care expenses are generally tax-free(not subject to Federal tax). However, certain states do tax these amounts.
  • Your balance can accumulate and roll over each year.
  • You can invest both your optional contribution and the company's contribution in your choice of mutual funds.
  • Your HSA is portable, so you can keep it if you switch jobs or retire.
  • You choose when to use your HSA. This means you can use it to pay for health care expenses (e.g. your deductible, coinsurance, etc.), or you can pay out of your own pocket and save your HSA funds.
  • You can pay health care expenses using your HSA debit card or by submitting a reimbursement form.

HSA Resources

Open your HSA Account -You must open your JPMorgan Chase bank account if you have enrolled in CIGNA/HAP Choice + HSA Plan to access your company and individual contributions. Once you access the Open your HSA Account link, you will need the following login id:

  • For new accounts, use Open Enrollment ID: Chrysler2 to log onto the application.
  • If you were already in the plan, you can ignore this step.

JPMorgan Chase HSA Rollover Form - If you have a Health Savings Account with another financial institution, you may roll that account into your JPMorgan Chase bank account.

Click here for more information on rollovers and account closure.

HSA Automatic Claim Forwarding Election Form - To request automatic reimbursement directly from your HSA account for CIGNA medical plan expenses.

Deposit Slip - To make a lump sum contribution directly to JPMorgan that is not payroll deducted.

JPMorgan Chase Brochure

Qualified Medical Expenses (IRS Publication 502)

HSA Tax-Favored Plans (IRS Publication 969)

Contribution Amounts

To change your HSA contribution amount through payroll deduction, contact Benefit Express at 1-888-456-7800.

Optional Employee
Company + Personal
Maximum Contribution
$500 (Retiree Only)
$1000 (Retiree + Family)
$2550 (Retiree Only)
$5150 (Retiree + Family)
$3050 (Retiree Only)
$6150 (Retiree + Family)

Comparing HSA and Flexible Spending Account (FSA)

HSA and FSA Features

For More Information

Phone: JPMorgan Chase at CIGNA: 1-800-244-6224
Phone: Benefit Express for changes to your payroll contribution amount: 1-888-456-7800


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Category : Benefits