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BENEFICIARY DESIGNATION FORM SelectAccount ID # Account Holder Information (Please Print) S Last Name First Name Middle Initial A Social Security # (if SA# is not known) Street Address City Account

How to fill out hsabeneficiary designation form

How to fill out hsabeneficiary designation form:

1. Start by gathering necessary information: Before filling out the form, make sure you have the following information ready - your full name, Social Security number, date of birth, and contact information.
2. Understand the purpose of the form: The hsabeneficiary designation form is used to designate one or more beneficiaries who will receive your health savings account (HSA) funds in the event of your death. It is important to carefully consider who you want to name as your beneficiaries.
3. Provide personal details: Begin filling out the form by entering your personal details such as your full name, Social Security number, and date of birth. Ensure that all information is accurate and up to date.
4. Name your primary beneficiary: The primary beneficiary is the person who will receive the HSA funds first. Typically, people choose their spouse or a family member as the primary beneficiary. Include their full name, relationship to you, and their contact information.
5. Consider naming contingent beneficiaries: Contingent beneficiaries are individuals who will receive the HSA funds if the primary beneficiary predeceases you or is unable to claim the funds. It is optional to name contingent beneficiaries, but it provides an additional layer of protection. Include their full names, relationships to you, and contact information.
6. Review the form and seek assistance if needed: Once you have completed filling out the form, carefully review all the information provided. Ensure that there are no errors or missing details. If you have any doubts or require assistance, reach out to your HSA provider or seek professional advice.

Who needs hsabeneficiary designation form:

1. Individuals with a health savings account (HSA): If you have an HSA, it is important to designate beneficiaries to ensure that your funds are distributed according to your wishes after your passing. Therefore, anyone who has an HSA should consider filling out the hsabeneficiary designation form.
2. Individuals who want to ensure proper asset distribution: By filling out the hsabeneficiary designation form, you can ensure that your HSA funds are distributed to the individuals you select. This helps avoid potential disagreements or complications regarding asset distribution.
3. Those who experience life changes: If you experience significant life changes such as getting married, divorced, having children, or the death of a beneficiary, you might need to update or revise your beneficiary designation. Therefore, it is important to regularly review and fill out the hsabeneficiary designation form when necessary.

Remember, it is crucial to consult with your HSA provider or a legal professional if you have specific inquiries or need personalized advice when filling out the hsabeneficiary designation form.

For pdfFiller’s FAQs

What is hsabeneficiary designation form?

The hsabeneficiary designation form is a document that allows HSA accountholders to designate who will receive the funds in their HSA account upon their death.

Who is required to file hsabeneficiary designation form?

All HSA accountholders are required to file a beneficiary designation form.

How to fill out hsabeneficiary designation form?

Accountholders can typically fill out the beneficiary designation form provided by their HSA administrator, specifying the name, relationship, and percentage of the funds allocated to each beneficiary.

What is the purpose of hsabeneficiary designation form?

The purpose of the hsabeneficiary designation form is to ensure that the funds in the HSA account are distributed according to the accountholder's wishes upon their death.

What information must be reported on hsabeneficiary designation form?

Accountholders must report the names, relationships, and percentages of funds allocated to each beneficiary on the beneficiary designation form.

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