Page 7 - Guide
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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 which works in conjunction with circumstances .
your health plan coverage. HSA dollars can be used to pay for qualiied Enrolled in an IRS qualiied high
medical expenses such as deductibles, copays, dental, and vision care. For deductible health plan (HDHP)
a complete list of qualiied medical expenses visit www.irs.gov in IRS Cannot be enrolled in a
Publication 502. traditional PPO plan through
your spouse or other employer
HSA Major Benefits sponsored plan options
Funds always belong to you Cannot be enrolled in a
Funds always roll over from year to year Government sponsored
program (Medicare, Medicaid,
Lowers your taxable income Tricare, etc .)
HSA Triple Tax Savings Cannot have received VA
Tax deduction when you contribute to your account beneits within the last three
months (unless receiving
Tax-free earnings through investment beneits for a service related
Tax-free withdrawal for qualiied medical expenses disability)
You may open an HSA through [Bank]. See a member of your Human Cannot be claimed as a
dependent on someone else’s
Resources team for more information. tax return
[20XX] HSA Funding Limits Cannot have an HSA and
Coverage Level Limit healthcare FSA; your spouse
Individual Coverage $3,400 cannot have a healthcare FSA
through his/her own employer
Family Coverage $6,750
Age 55 or Older Contribute an additional $1,000 on top of these amounts
[Client Name] 7
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 which works in conjunction with circumstances .
your health plan coverage. HSA dollars can be used to pay for qualiied Enrolled in an IRS qualiied high
medical expenses such as deductibles, copays, dental, and vision care. For deductible health plan (HDHP)
a complete list of qualiied medical expenses visit www.irs.gov in IRS Cannot be enrolled in a
Publication 502. traditional PPO plan through
your spouse or other employer
HSA Major Benefits sponsored plan options
Funds always belong to you Cannot be enrolled in a
Funds always roll over from year to year Government sponsored
program (Medicare, Medicaid,
Lowers your taxable income Tricare, etc .)
HSA Triple Tax Savings Cannot have received VA
Tax deduction when you contribute to your account beneits within the last three
months (unless receiving
Tax-free earnings through investment beneits for a service related
Tax-free withdrawal for qualiied medical expenses disability)
You may open an HSA through [Bank]. See a member of your Human Cannot be claimed as a
dependent on someone else’s
Resources team for more information. tax return
[20XX] HSA Funding Limits Cannot have an HSA and
Coverage Level Limit healthcare FSA; your spouse
Individual Coverage $3,400 cannot have a healthcare FSA
through his/her own employer
Family Coverage $6,750
Age 55 or Older Contribute an additional $1,000 on top of these amounts
[Client Name] 7
