Get the free Health Savings Account (HSA) Transfer/Rollover Request Form

This form is used to request a transfer or rollover of a Health Savings Account (HSA) to HSA Bank from another trustee or custodian. It requires the accountholder to provide their personal information,

How to fill out health savings account hsa

How to fill out Health Savings Account (HSA) Transfer/Rollover Request Form

1. Obtain the HSA Transfer/Rollover Request Form from your HSA provider or their website.
2. Fill in your personal information, including your name, address, and Social Security number.
3. Provide the information of the current HSA custodian from which the funds are being transferred.
4. Specify the amount you wish to transfer or rollover, ensuring it adheres to IRS guidelines.
5. Sign and date the form to authorize the transfer.
6. Submit the completed form to your current HSA custodian and keep a copy for your records.

Who needs Health Savings Account (HSA) Transfer/Rollover Request Form?

1. Individuals looking to transfer HSA funds from one custodian to another.
2. People who want to consolidate multiple HSAs into a single account.
3. Those who have changed jobs and need to move their HSA funds to a new provider.
4. Account holders who want to take advantage of better interest rates or investment options.

People Also Ask about

How long does it take for HSA to transfer to bank account online?

How long will an HSA transfer take? It may take 2–5 weeks or, in some cases, more, depending on how quickly your current HSA provider responds. If any of your HSA money is invested, your current HSA may be held in 2 separate accounts which are both eligible to be transferred.

How do I transfer my HSA to my bank account?

Online Transfer – On HSA Bank's Member Website, you can transfer funds from your HSA to an external bank account, such as a personal checking or savings account. There is a daily transfer limit of $2,500 to safeguard against fraudulent activity.

Can I transfer money from HSA to my bank account?

Online Transfers – On HSA Bank's member website, you can reimburse yourself for out-of-pocket expenses by making a one-time or reoccurring online transfer from your HSA to your personal checking or savings account.

How to request HSA rollover?

You can contact your current HSA provider and request a trustee-to-trustee transfer, or ask for a check and complete the rollover yourself. If you choose the latter, be sure to deposit the funds into your new HSA within 60 days to avoid taxes and penalties.

What happens to HSA if I move abroad?

So rest assured, you can use your HSA when traveling abroad. However, there are limitations as to what you can spend your money on tax-free. And keep in mind you may also need to pay extra fees, depending on your HSA provider.

What is the difference between an HSA rollover and transfer?

What's the difference between an HSA transfer and a rollover? An HSA transfer occurs when your HSA trustee directly moves your money into your new HSA for you. With an HSA rollover, the trustee sends you the money, and you must deposit it into your new HSA within 60 days to avoid penalties.

Can I convert my HSA to cash?

If you're under the age of 65, you can withdraw money from your HSA (i.e. take a distribution) to pay for qualified medical expenses. If you use your HSA contributions to pay for anything else, you will have to pay income taxes on the withdrawn amount as well as a 20% penalty.

Where is the best place to rollover an HSA?

The easiest and most secure way to start an HSA rollover is by contacting your current HSA provider. This might be a bank, mutual fund company or another financial institution. If your HSA was set up through your employer, the benefits department can direct you to the right contact.

For pdfFiller’s FAQs

What is Health Savings Account (HSA) Transfer/Rollover Request Form?

The Health Savings Account (HSA) Transfer/Rollover Request Form is a document used to request the transfer or rollover of funds from one HSA to another. This form facilitates the movement of funds without incurring taxes or penalties.

Who is required to file Health Savings Account (HSA) Transfer/Rollover Request Form?

Individuals who wish to transfer or rollover funds from their existing HSA to a new HSA must file the Health Savings Account (HSA) Transfer/Rollover Request Form.

How to fill out Health Savings Account (HSA) Transfer/Rollover Request Form?

To fill out the form, provide personal information such as account holder's name, address, and Social Security number, details of the existing HSA, the receiving HSA information, and sign the form to authorize the transfer.

What is the purpose of Health Savings Account (HSA) Transfer/Rollover Request Form?

The purpose of the form is to enable the holder to efficiently and properly transfer or rollover funds between HSAs, ensuring adherence to IRS regulations while preserving the tax-advantaged status of the funds.

What information must be reported on Health Savings Account (HSA) Transfer/Rollover Request Form?

The form must include the account holder's personal information, details of the current HSA (account number and financial institution), details of the new HSA (account number and financial institution), and the signature of the account holder.