Health Savings Account (HSA)

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If you enroll in the High Deductible Health Plan (HDHP) with HSA, you can open a Health Savings Account (HSA) to pay for eligible healthcare expenses today and save for future healthcare needs.

Unlike a Flexible Spending Account (FSA), unused HSA funds roll over from year to year and remain yours to keep, even if you leave T-Mobile or retire. You can also invest part of your HSA contributions to grow your savings.

T-Mobile Helps You Save

T-Mobile contributes to your HSA when you enroll in the HDHP with HSA Plan. Contributions to your HSA may be made by you, T-Mobile or another individual. All funds contributed to your HSA are owned and controlled by you, subject to reasonable administrative restrictions imposed by the account trustee.

Why Consider an HSA?

Triple Tax Advantage

Contributions are deducted from your paycheck tax-free
Earnings and investment growth are tax-free
Withdrawals for eligible healthcare expenses are tax-free
Contributions made outside payroll may be tax-deductible.
Employer contributions are not taxable.

Coverage Tier	T-Mobile Contribution	2026 Contribution Limit	2027 Contribution Limit
Employee Only	$500	$4,400	$4,500
Employee + Dependents	$1,000	$8,750	$9,000
T-Mobile contributions are distributed throughout the year through payroll and count toward your maximum annual contributions. Employees aged 55 or older can contribute an additional $1,000 each year. T-Mobile’s funding is prorated across 26 pay periods each year. T-Mobile contributes $19.23 per pay period for employee-only coverage and $38.46 per pay period for employee-plus-spouse, employee-plus-child or children, and family coverage. Current federal contribution limits are available on the IRS website.

Coverage Tier

T-Mobile Contribution

2026 Contribution Limit

2027 Contribution Limit

Employee Only

$500

$4,400

$4,500

Employee + Dependents

$1,000

$8,750

$9,000

T-Mobile contributions are distributed throughout the year through payroll and count toward your maximum annual contributions. Employees aged 55 or older can contribute an additional $1,000 each year.

T-Mobile’s funding is prorated across 26 pay periods each year. T-Mobile contributes $19.23 per pay period for employee-only coverage and $38.46 per pay period for employee-plus-spouse, employee-plus-child or children, and family coverage. Current federal contribution limits are available on the IRS website.

To contribute to an HSA, you must:

Be enrolled in the HDHP with HSA Plan
Not be enrolled in Medicare
Not be claimed as a dependent on another person's tax return
Not have other coverage that would make you ineligible for HSA contributions
Not participate in a full-purpose Healthcare FSA, including through a spouse

You can use HSA funds to pay for eligible:

Medical expenses
Prescription drugs
Dental care
Vision care
Deductibles, copays, and coinsurance

Eligible expenses may include costs incurred by you, your spouse and dependents claimed on your tax return.

Funds roll over year after year
There is no "use it or lose it" rule
The account belongs to you
Your funds remain yours if you change jobs or retire

When You Can Contribute

Contributions may begin on the first day of the month you enroll in the HSA Plan and may generally be made until you file taxes for that year, subject to the annual contribution limit. If your qualified high-deductible health plan coverage ends, you may no longer contribute to your HSA.

When Your Employment Ends

If your employment ends, you continue to own and control your HSA funds whether or not you elect COBRA coverage for the accompanying high-deductible health plan. If you elect COBRA, you may use your HSA funds for eligible medical-plan out-of-pocket expenses and COBRA premiums while coverage remains in effect.

If you enroll in the HSA Plan during the year rather than on January 1, you may still contribute up to the annual maximum allowed under federal regulations. However, you must remain enrolled in a qualified high-deductible health plan through the end of the 12th month following your initial enrollment. Otherwise, your contributions will become taxable and subject to an additional 10% tax.

Contributions exceeding the annual maximum are not tax-deductible and may be subject to an excise tax unless withdrawn as an excess contribution before April 15 of the following year.

After enrolling in the HSA Plan with UnitedHealthcare, administered by Optum Bank, or Premera Blue Cross, administered by Optum Financial, you may be asked to provide additional information before your account can be opened. This verification is required under federal law as part of the USA PATRIOT Act. UnitedHealthcare or Premera Blue Cross will notify you if additional information is required and provide a deadline for responding.

If the requested information is not provided by the deadline:

Your HSA will not be opened.
Contributions withheld from your pay will be returned as taxable income.
Future employee contributions will stop.
Scheduled T-Mobile contributions will be forfeited.

If you successfully open an HSA later, you may elect to restart contributions. Contributions will only be made prospectively.

HSA funds used for nonmedical expenses are generally subject to income tax and an additional 20% tax. The additional tax does not apply when an exception applies, including death, disability or attainment of age 65.

HSA funds generally cannot be used to pay health insurance premiums without tax consequences. Exceptions may apply to:

Long-term care insurance premiums
COBRA premiums
Medicare premiums
Health coverage premiums paid while you are unemployed

For a current list of eligible medical expenses, refer to IRS Publication 502.

Important Differences Between an HRA and HSA

HRA	HSA
Funded only by T-Mobile	Funded by you and T-Mobile
Employees cannot contribute	Employees can contribute
Available only with the PPO Plan with HRA	Available only with the HDHP with HSA
No impact on taxable income	Employee contributions can lower your taxable income
Funds generally remain with the plan if coverage ends	Funds belong to you and remain yours if you change jobs or retire

Keep Your Receipts and Records

Keep your receipts and medical records to demonstrate that HSA distributions were used for qualified healthcare expenses. Without supporting documentation, distributions may be subject to income tax and possibly an additional penalty.

T-Mobile, UnitedHealthcare and Premera Blue Cross do not verify whether HSA distributions are used for qualified healthcare expenses. Consult a tax advisor to determine how an HSA affects your individual tax situation. T-Mobile and the claims administrators are not responsible or liable for taxes or penalties resulting from using HSA funds for expenses that are not qualified healthcare expenses.

Carrier Contact Info

Log On to the Enrollment Site

(866) 358-2300
premera.com/t-mobile
Group #4022154
Hours: M-F 5 a.m. – 8 p.m. PST

(800) 791-9361
myuhc.com
Group #222244
Hours: M-F 8 a.m. – 8 p.m. PST

Resources

HSA Overview

Consolidating HSA Accounts

HSA & Medicare FAQs

Premera Blue Cross Investment Guide

UHC Investment Guide

Prescription Plans	Surest Copay Only	PPO Plan with Health Reimbursement Account (HRA Plan)	Exclusive Provider Organization (EPO Plan)	High Deductible Health Plan with Health Savings Account (HSA Plan)
Tier 1 (30 days)	$10 copay	10% ($5 copay min.-$20 copay max.)	$10 copay	Plan pays 80% after deductible
Tier 2 (30 days)	$75 copay	20% ($25 copay min.-$55 copay max.)	$35 copay	Plan pays 80% after deductible
Tier 3 (30 days)	$200 copay	30% ($45 copay min.-$80 copay max.)	$60 copay	Plan pays 80% after deductible
Mail Order/Retail (90 days)	2x monthly rate	2x monthly rate	2x monthly rate	Plan pays 80% after deductible
Preventive Medications	Subject to normal copay	Many are free	Subject to normal copay	Many are free
Weight loss Medications (anti-obesity and anorexiants)	2027: $100 copay max 2026: $55 copay max	2027: $100 copay max 2026: $55 copay max	2027: $100 copay max 2026: $55 copay max	Plan pays 80% after deductible
*The other differences are that in the HRA and HSA Plans, a robust list of preventive medications are FREE. You can review the covered preventive prescriptions and others, as well as costs at info.caremark.com/oe/t-mobile.

Coverage Election	Dental				Vision
	PPO Network		Open Network		Vision
	Employee	Employer	Employee	Employer	Employee	Employer
Employee Only	$6.00	$7.31	$17.00	$6.95	$3.50	$0.00
Employee plus Spouse	$12.00	$12.62	$31.00	$13.31	$6.00	$0.00
Employee plus Children	$14.00	$15.28	$37.00	$15.69	$6.00	$0.00
Employee plus Family	$20.00	$20.59	$52.00	$21.05	$9.50	$0.00
Domestic Partner¹	$6.00	$5.31	$14.00	$6.36	$2.50	$0.00
Domestic Partner Child¹	$8.00	$7.97	$20.00	$8.74	$2.50	$0.00
¹Domestic Partner deductions are taken on a post-tax basis, and employee pays tax on the employer portion of the contribution.

Coverage Election	Surest Copay Only Plan	PPO Plan with Health Reimbursement Account	Exclusive Provider Organization (EPO) Plan	High Deductible Health Plan with Health Savings Account (HSA)
Employee	$10.25	$52.88-$100	$108.39-$162	$44.97-$91
Employee + Spouse	$36	$121.28-$216	$232.28-$340	$105.45-$198
Employee + Children	$26	$104.12-$189	$202.64-$300	$90.21-$174
Employee + Family	$42	$163.05-$304	$336.39-$498	$137.53-$275
Additional Working Partner Premium	$46.15	$46.15	$46.15	$46.15

Coverage Election	Surest Copay Only Plan	PPO Plan with Health Reimbursement Account	Exclusive Provider Organization (EPO) Plan	High Deductible Health Plan with Health Savings Account (HSA)
Employee	$10.25	$48.62-$91	$98.57-$147	$41.50-$83
Employee + Spouse	$36	$112.75-$198	$212.65-$310	$98.50-$182
Employee + Children	$26	$96.31-$173	$184.97-$272	$83.78-$159
Employee + Family	$42	$150.94-$278	$306.94-$453	$127.97-$252
Additional Working Partner Premium	$46.15	$46.15	$46.15	$46.15
If you have a domestic partner or child of your domestic partner enrolled on the medical plan, the amount T-Mobile pays for your domestic partner/child of domestic partner coverage is added to your paycheck as taxable income because the IRS does not consider either to be a tax dependent. For additional information, please log in to your account at www.t-mobilebenefits.com/login.

Medical Plans	Surest Copay Only	PPO Plan with Health Reimbursement Account (HRA Plan)	High Deductible Health Plan with Health Savings Account (HSA Plan)	Exclusive Provider Organization (EPO Plan)
Calendar Year Deductible
Individual	$0	$2,250	$2,250	$750
Enrolled dependents	$0	$4,500	$4,500	$1,500
T-Mobile Account Funding (coverage on Jan 1)
Individual	N/A	$500*	$500**	N/A
Enrolled dependents	N/A	$1,000*	$1,000**	N/A
T-Mobile Account Funding (coverage Feb 1 or after)
Individual	N/A	$41.66/month*	$19.23/pay period**	N/A
Enrolled dependents	N/A	$83.33/month*	$38.46/pay period***	N/A
Out-of-Pocket Max (includes the deductibles)
Individual	$6,500	$4,250	$4,250	$3,750
Enrolled dependents	$13,000	$8,500	$8,500***	$7,500
Coinsurance (starts after deductible is met)	N/A	80% in-network, 60% out-of-network up to R&C	80% in-network, 60% out-of-network up to R&C	80% in-network only, NO coverage out-of-network
Office Visits
Preventive	FREE	FREE	FREE	FREE
In-person primary care physician (or a virtual care physician, if available)	$25-$130	$35	Deductible + coinsurance	$20
24/7 virtual medical care with a designated provider in the following networks: Premera Blue Cross enrollees: Doctor on Demand and 98point6 UHC enrollees: Teladoc, Optum Virtual Care, Walmart Health Virtual Care, Amwell, Doctor on Demand Surest enrollees: Amwell, Doctor on Demand, Alma, Talkspace	FREE	FREE	Deductible + coinsurance	FREE
In-person specialist	$25-$130	$50	Deductible + coinsurance	$30
In-person behavioral health visit with a licensed therapist	$25-$130	$35 (in or out of network)	Deductible + coinsurance	$20
Virtual behavioral health care with licensed psychiatrists or therapists in the following networks: Premera Blue Cross enrollees: Doctor on Demand and Talkspace UHC enrollees: Amwell, Doctor on Demand and Talkspace	$0-$130	$35	Deductible + coinsurance	$20
Emergency room	$600 copay	$200 copay, then 80% after deductible (copay waived if admitted)	80% after deductible	$200 copay, then 80% after deductible (copay waived if admitted)
To view cost estimate comparisons for how much you might spend out of pocket for certain services under each plan, click here. Entire T-Mobile funding is available first day of coverage. Any balance rolls over to the next year, up to $6,000 as long as you remain in the plan. T-Mobile contributions are prorated and funded by the Friday following each pay date. Any funds in your HSA are yours to keep, even if you leave T-Mobile. **The High Deductible Health Plan with HSA Plan features a true family deductible. The family deductible is two times the individual deductible and requires that the entire family deductible is met before paying 80% of covered charges. Please note that the out-of-pocket maximum works the same way.

Health Savings Account (HSA)

T-Mobile Helps You Save

Why Consider an HSA?

What to Know Before You Enroll

What Can I Use My HSA For?

Your Money Stays With You

When You Can Contribute

When Your Employment Ends

Important Contribution RulesExpand

Opening Your HSAExpand

Additional HSA Expense RulesExpand

Consolidating Your HSA FundsExpand

Important Differences Between an HRA and HSA

Keep Your Receipts and Records

Resources

Money on the Table

Buffet of Services

Don't Wait for a Breakdown

The Umbrella Effect

Virtual Care Delivers

Surest

PPO with Health Reimbursement Account

High Deductible Health Plan with HSA

EPO Plan

Supplemental Health Plans

HMSA HMO and PPO:

HMSA Health Plan Hawaii Plus (HMO):

HMSA Preferred Provider Plan (PPO):

New Lyra Support for You and Your Family

Enhancements to all Aflac Plans

Enhanced Virtual Musculoskeletal Care Benefit

Enhanced Decision-Making Tool

Expanded Family-Building and Maternity Support

New LightCare Vision Benefit

Cost Per Pay Period Is Changing

Weight Loss Medication Cost Increase

Select Voluntary Benefits Now Available Through the Enrollment Experience

New Health Savings Account (HSA) Limits Are Increasing

Hawaii Medical Plan Changes