Get the free Health Savings Account (HSA) Rollover or Transfer Request Form - sscc

This form is used to authorize the rollover or transfer of Health Savings Account (HSA) assets from another Custodian/Trustee to OptumHealth Bank HSA.

How to fill out health savings account hsa

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

1. Obtain the Health Savings Account (HSA) Rollover or Transfer Request Form from your HSA provider.
2. Fill in your personal information, including your name, address, and HSA account number.
3. Specify the type of transaction you are requesting (either a rollover or a transfer).
4. If transferring, include the information for the current HSA provider, including their name and contact details.
5. If rolling over funds, provide details on the account you are moving the funds from.
6. Sign and date the form to authorize the transaction.
7. Submit the completed form to your HSA provider by mail, fax, or online submission as instructed.

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

1. Individuals who want to transfer their HSA funds from one account to another.
2. People who have received a distribution from their HSA and want to roll it over into another HSA.
3. Those changing employers and moving their HSA to a new provider.

People Also Ask about

Is HSA a rollover or transfer?

Once you've had an HSA-eligible health plan and opened an HSA, the money in it is yours to keep and do with as you please (within plan and IRS rules), including transferring it to a new HSA at a different provider through what's called an HSA rollover.

How do I get my HSA form?

There are two sets of tax forms: Your annual tax Form 1099 will be mailed to the address on file by January 31 each year. Your annual tax Form 5498 will be mailed to the address on file by May 31 each year.

How to transfer funds out of HSA bank?

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.

Is HSA or FSA rollover?

HSA: You have a big advantage here. With an HSA, your money rolls over every year. And it's always yours, even if you switch jobs. FSA: Use it within the year, or you might lose it.

Does health equity HSA roll over?

Roll over funds Unlike Flexible Spending Accounts (FSA), you own your HSA. That means your entire balance rolls over every year — even if you change health plans, retire, or leave your employer.

How to request HSA rollover?

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.

Does HSA roll over to a new employer?

Key takeaways. Your HSA is yours even if you leave the employer sponsoring your plan. When changing jobs, you can consolidate your old HSA into a new HSA offered by your next employer, keep your old HSA, or roll over to a new HSA under a different financial services firm.

Is a HSA a transfer or rollover?

It differs from transfers in that your HSA provider sends your current HSA funds to you and not directly to your new HSA provider. That means the IRS views a rollover as a distribution from your account and you must deposit the money received in a new HSA within 60 days to avoid paying a 20% penalty and income taxes.

For pdfFiller’s FAQs

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

The Health Savings Account (HSA) Rollover or Transfer Request Form is a document used to initiate the transfer of funds from one HSA to another or to withdraw funds from an HSA account in a tax-free manner.

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

Individuals who wish to move their funds from one HSA to another or those who are transferring funds from an HSA to another qualified account are required to file this form.

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

To fill out the form, provide personal details, account information for both the originating and receiving HSAs, and specify the amount to be rolled over or transferred. Follow the provided instructions carefully.

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

The purpose of the form is to facilitate the tax-free transfer of HSA funds to ensure that the account holder can maintain or consolidate their HSA assets without triggering tax penalties.

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

The form must include the account holder's personal information, details of the current HSA, details of the new HSA, and the amount being rolled over or transferred.