Get the free Health Savings Account (HSA) Enrollment Form

This document serves as an enrollment form for individuals to apply for a Health Savings Account (HSA) with UMB Bank, n.a. It collects personal information and certifies eligibility for opening an

How to fill out health savings account hsa

How to fill out Health Savings Account (HSA) Enrollment Form

1. Obtain the Health Savings Account (HSA) Enrollment Form from your employer or HSA provider.
2. Read the instructions carefully to understand the required information.
3. Provide personal details such as your name, address, date of birth, and Social Security number.
4. Indicate your eligibility for the HSA by checking the appropriate box.
5. Select the amount you wish to contribute to your HSA, including any employer contributions.
6. Fill out the beneficiary information, specifying who will receive the funds in case of your death.
7. Review your information for accuracy and completeness.
8. Sign and date the form to confirm your enrollment.
9. Submit the completed form to your employer or HSA provider as instructed.

Who needs Health Savings Account (HSA) Enrollment Form?

1. Individuals who are enrolled in a high-deductible health plan (HDHP).
2. Those looking to save for qualified medical expenses on a tax-advantaged basis.
3. Employees whose employers offer HSA provisions as part of their benefits package.
4. Self-employed individuals seeking a way to manage healthcare costs.

People Also Ask about

Who sends out HSA tax forms?

IRS Form 8889 is used to report HSA contributions, distributions and your tax deductions. You will complete this form using IRS Forms 1099-SA and 5498-SA provided by HSA Bank.

Can I open an HSA account online?

You must report contributions from your HSA on IRS Form 8889. Get 5498-SA information in the "If I don't have a 5498-SA, how can I get my contributions by tax year?" question. Find a sample 5498-SA form from the IRS. The HSA Bank 5498-SA form may look slightly different, but it will contain the same information.

Where can I get an HSA form?

How do I find my HSA tax forms? Log in to your account and select Manage My Reimbursement Account. Click the red menu on the top left, click My Accounts, then select Benefit Account Summary. Select the Tax Forms link in the Account Resources section. You may be prompted to complete a PDF verification step.

Where do I get my 1099-SA for HSA?

The 1099-SA form will be available mid-to-late January in your online account if you had distributions in the prior year. If you chose to get paper documents, you'll get your 1099-SA in the mail in late January/early February.

What proof do I need for HSA?

For FSAs, HSAs, and some HRAs, a detailed provider receipt or itemized cash register receipt is usually sufficient, if it contains all the required information listed above. For some HRAs, an Explanation of Benefits (EOB) from your insurance company is required.

Do I have to report my health savings account on taxes?

However, an eligible employee can set up an HSA at any time, not just during open enrollment. Also, employees can generally elect to start making pre-tax contributions to their HSAs at any time during the plan year, even if they did not elect HSA contributions during open enrollment.

For pdfFiller’s FAQs

What is Health Savings Account (HSA) Enrollment Form?

The Health Savings Account (HSA) Enrollment Form is a document used to enroll individuals in an HSA, allowing them to set aside money on a tax-advantaged basis for medical expenses.

Who is required to file Health Savings Account (HSA) Enrollment Form?

Individuals who are eligible to contribute to an HSA, typically those enrolled in a high-deductible health plan (HDHP), are required to complete the HSA Enrollment Form.

How to fill out Health Savings Account (HSA) Enrollment Form?

To fill out the HSA Enrollment Form, individuals need to provide personal information such as name, address, and Social Security number, along with details about their HDHP and their contribution preferences.

What is the purpose of Health Savings Account (HSA) Enrollment Form?

The purpose of the HSA Enrollment Form is to officially register an individual for an HSA, enabling them to make tax-deductible contributions and use funds for qualified medical expenses.

What information must be reported on Health Savings Account (HSA) Enrollment Form?

The information required on the HSA Enrollment Form typically includes the individual's identification details, HDHP information, and specifics about how much they wish to contribute to the account.