Page 9 - Enrollment Guide Example
P. 9
HSA HSA Eligibility
What is a Health Savings Account (HSA)? You may open and contribute pre-
tax to an HSA under the following
An HSA is a tax-favored savings account that works in conjunction with circumstances.
your health plan coverage. HSA dollars can be used to pay for qualiied Enrolled in an IRS qualiied
medical expenses such as deductibles, copays, dental, and vision care. For high deductible health plan
a complete list of qualiied medical expenses visit www.irs.gov in IRS (HDHP)
Publication 502.
Cannot be enrolled in a
HSA Major Benefits traditional PPO plan through
Funds always belong to you your spouse or other
employer sponsored plan
Funds always roll over to use the following year options
Lowers your taxable income Cannot be enrolled in a
Government sponsored
HSA Triple Tax Savings program (Medicare, Medicaid,
Tax deduction when you contribute to your account Tricare, etc.)
Tax-free earnings through investment Cannot have received VA
Tax-free withdrawal for qualiied medical expenses beneits within the last three
months (unless receiving
You may open an HSA through [Bank]. See a member of your Human beneits for a service related
disability)
Resources team for more information.
Cannot be claimed as a
[20XX] HSA Funding Limits dependent on someone else’s
Coverage Level Limit tax return
Individual coverage $3,350 Cannot have an HSA and
Family coverage $6,750 healthcare FSA; your spouse
Age 55 or older Contribute an additional $1,000 on top of these amounts cannot have a healthcare
FSA through his/her own
Newly Hired Employees—Contribution Limits employer
The limits illustrated are for enrollment in the HSA for the full
calendar year. If you enroll mid-year, you need to prorate your personal
contribution limit.
To pro-rate, take the total allowed annual contribution based on your
coverage level, multiply it by the number of months in the year you
qualify, then divide the amount by 12. For example, you enroll in the HSA
on April 1, your annual contribution limit is: $3,350 X 9 ÷ 12 = $2,512.50.
9
What is a Health Savings Account (HSA)? You may open and contribute pre-
tax to an HSA under the following
An HSA is a tax-favored savings account that works in conjunction with circumstances.
your health plan coverage. HSA dollars can be used to pay for qualiied Enrolled in an IRS qualiied
medical expenses such as deductibles, copays, dental, and vision care. For high deductible health plan
a complete list of qualiied medical expenses visit www.irs.gov in IRS (HDHP)
Publication 502.
Cannot be enrolled in a
HSA Major Benefits traditional PPO plan through
Funds always belong to you your spouse or other
employer sponsored plan
Funds always roll over to use the following year options
Lowers your taxable income Cannot be enrolled in a
Government sponsored
HSA Triple Tax Savings program (Medicare, Medicaid,
Tax deduction when you contribute to your account Tricare, etc.)
Tax-free earnings through investment Cannot have received VA
Tax-free withdrawal for qualiied medical expenses beneits within the last three
months (unless receiving
You may open an HSA through [Bank]. See a member of your Human beneits for a service related
disability)
Resources team for more information.
Cannot be claimed as a
[20XX] HSA Funding Limits dependent on someone else’s
Coverage Level Limit tax return
Individual coverage $3,350 Cannot have an HSA and
Family coverage $6,750 healthcare FSA; your spouse
Age 55 or older Contribute an additional $1,000 on top of these amounts cannot have a healthcare
FSA through his/her own
Newly Hired Employees—Contribution Limits employer
The limits illustrated are for enrollment in the HSA for the full
calendar year. If you enroll mid-year, you need to prorate your personal
contribution limit.
To pro-rate, take the total allowed annual contribution based on your
coverage level, multiply it by the number of months in the year you
qualify, then divide the amount by 12. For example, you enroll in the HSA
on April 1, your annual contribution limit is: $3,350 X 9 ÷ 12 = $2,512.50.
9
