S-139 SelectAccount Individual HSA 2014

First, approximately how long have you had your health savings account (HSA) with SelectAccount?

Less than 1 year

1 – 2 years

3 – 5 years

6 years or longer

How would you rate your satisfaction with SelectAccount on the overall administration of your HSA?

Please select from the following statements on how you primarily use your HSA:

I primarily use my HSA money to pay for medical expenses as they occur

I primarily use my HSA as a savings account

* Approximately how many withdrawals from your health savings account have you had in the past 12 months?

Which of the following methods have you used for withdrawals from your HSA in the past 12 months?

Debit card

On-line withdrawal request

Crossover (SelectAccount automatically receives claims from the health plan and pays claims as long as you have funds available)

Paper form you faxed or mailed in

* Do you use the direct deposit option to be reimbursed from your HSA account after you have paid a bill (automatic payment directly into your checking or savings account)?

Yes

No

Don’t know

Why don’t you use direct deposit for reimbursements from your HSA?

Always use my debit card

Haven’t had any reimbursements from my HSA

Didn’t know it was available

Another reason (please specify)

Do you make regular contributions to your HSA?

Yes

No

* Are you a registered user and have you accessed your secure account information through our website at SelectAccount.com in the past 12 months?

Yes

No

Why haven’t you accessed your secure account information at SelectAccount.com to manage your personal HSA account?

Lack of time

I prefer to call customer service

I didn’t know about the website

I haven’t had any questions, problems or the need to use it

I don’t have the login information (username, password)

I get the information through my health plan website

Some other reason (please specify)

Please rate your satisfaction with SelectAccount’s website:

How satisfied are you with your ability to get the information you need from SelectAccount’s website?

What do you primarily use the website for?

Check balance

Check for receipt of submitted claim

Claim payments

Some other reason (please specify)

What would you suggest to make the website better?

* Have you called SelectAccount Customer Service in the past 12 months?

Yes

No

Overall, how satisfied are you with the customer service you receive from SelectAccount when you call?

Why are you dissatisfied with the customer service you receive from SelectAccount when you call?

What was the purpose of your most recent contact with SelectAccount Customer Service?

Balance information/election question

Reimbursement question/status

Ask about eligible expenses

Maximum contribution/annual contribution question

Get information to be able to access your account online (username, password)

Other (please specify)

Was your inquiry resolved so that you did not have to call back again on the same issue?

Yes

No

Thinking about your most recent contact with SelectAccount’s Customer Service, please rate your experience in each of the following areas:

Please tell us a little bit about yourself...

What is the highest level of education you have completed?

High school or less

Some college or technical school – no degree

2 year college degree/technical school degree

4 year college degree

Post graduate work or degree

Prefer not to answer

What is your gender?

Male

Female

Which of the following age groups do you belong to?

In general, how would you describe your current health?

Which of the following broad ranges best describes your annual household income before taxes?

Less than $35,000

$35,000 to less than $50,000

$50,000 to less than $75,000

$75,000 to less than $100,000

$100,000 to less than $150,000

$150,000 or more

Prefer not to answer

What additional comments or suggestions do you have for SelectAccount?