Health Savings Account (HSA)

HSAs allow for tax-deductible contributions and tax-free distributions if distributed amounts are used to pay for qualified medical expenses. Qualified medical expenses include expenses incurred by spouses and dependents even if they are not eligible for an HSA. Although employers may contribute to an employee’s HSA, each HSA is owned and controlled by the individual, not the employer.

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Are your Eligible?

To be eligible for an HSA contribution type listed below, all statements for that contribution type must be true. Refer to page 2 for rules and conditions that apply to contribution eligibility.

REGULAR (Includes catch-up contributions and qualified HSA funding distributions from an IRA)

I am covered by an HSA-eligible high deductible health plan (HDHP).
I am not covered by a nonHDHP that provides coverage for any benefit that is also covered under the HDHP (with limited exceptions).

I am not enrolled in Medicare.
I am not eligible to be claimed as a dependent on another person’s tax return.

If this contribution is a qualified HSA funding distribution from your IRA, the following statements also must be true.

I have not previously completed a qualified HSA funding distribution from my IRA.
This is a direct movement of assets from my IRA into this HSA.

ROLLOVER (Distribution from an HSA or Archer MSA that is being deposited into this HSA)

I received the assets from the distributing HSA or Archer MSA within the last 60 days.
I have not rolled over any assets to an HSA in the last 12 months.

Other Questions:

Is it a personal or family HSA?
Do you want an authorized signer?
Do you want to have access through online banking or direct deposit from your employer? (this is a yes or no, not one or the other)
Do you and your authorized signer need a debit card?