Get the free HSA Beneficiary Form - HealthSCOPE Benefits

HSA BENEFICIARY CHANGE/SPOUSAL CONSENT FORM 1. Use this form to designate or change your beneficiary. List additional beneficiaries on the back. Beneficiaries will remain in effect until changed.

How to fill out hsa beneficiary form

How to fill out the HSA beneficiary form:

1. Obtain the form: The HSA beneficiary form can usually be obtained from your HSA provider or employer. Contact them to request the form if you do not already have one.
2. Personal information: Start by filling out your personal information on the form. This typically includes your full name, address, date of birth, and Social Security number. Double-check all the information for accuracy.
3. Choose your beneficiary: Indicate who you want to be the beneficiary of your HSA account in case of your death. This can be a spouse, child, parent, or any other individual you choose. Make sure to provide the beneficiary's full name, relationship to you, and their contact information.
4. Specify the percentage or allocation: If you have multiple beneficiaries, you may need to specify the percentage or allocation each beneficiary should receive. This determines how your HSA funds will be distributed among the beneficiaries.
5. Appoint a contingent beneficiary: It's a good idea to designate a contingent beneficiary who would receive the HSA funds if the primary beneficiary is unable or unwilling to accept them. Provide the contingent beneficiary's details as well.
6. Signature and date: Read through the form carefully and make sure you understand all the terms and conditions. Once you are satisfied, sign and date the form indicating your consent and agreement.
7. Submit the form: After completing the form, submit it to your HSA provider or employer as directed. Keep a copy of the filled-out form for your records.

Who needs an HSA beneficiary form:

1. HSA account holders: If you have a Health Savings Account (HSA), it is highly recommended to complete a beneficiary form. This ensures that your HSA funds are distributed according to your wishes in the event of your death.
2. Individuals with dependents: If you have dependents who would rely on your HSA funds for medical expenses, it is crucial to designate a beneficiary. This helps provide financial security for your loved ones.
3. Married account holders: Even if you are married, your HSA funds are not automatically transferred to your spouse upon your death. By completing an HSA beneficiary form, you can specify your spouse as the primary beneficiary or choose someone else if desired.
4. Account holders without immediate family: If you do not have a spouse or children, you may want to designate a sibling, close friend, or charity as the beneficiary of your HSA account. This ensures that your HSA funds go to the intended recipient.

Remember to review and update your HSA beneficiary form periodically or as life circumstances change to ensure it reflects your current wishes.

For pdfFiller’s FAQs

What is hsa beneficiary form?

The HSA beneficiary form is a document that designates who will receive the funds in your Health Savings Account (HSA) upon your death.

Who is required to file hsa beneficiary form?

Any individual who has a Health Savings Account (HSA) should consider filing a beneficiary form to designate who will receive the funds in the account upon their death.

How to fill out hsa beneficiary form?

To fill out the HSA beneficiary form, you will need to provide the name and contact information of the beneficiary as well as their relationship to you. You may also need to specify the percentage of the account balance they will receive.

What is the purpose of hsa beneficiary form?

The purpose of the HSA beneficiary form is to ensure that your HSA funds are transferred to the designated beneficiary in the event of your death.

What information must be reported on hsa beneficiary form?

The HSA beneficiary form typically requires the beneficiary's name, contact information, relationship to the account holder, and the percentage of funds they will receive.

What is the penalty for late filing of hsa beneficiary form?

The penalty for late filing of the HSA beneficiary form may result in complications with transferring the funds to the designated beneficiary, and potential tax implications. It is recommended to file the form in a timely manner to avoid any penalties.

How do I complete hsa beneficiary form online?

pdfFiller makes it easy to finish and sign hsa beneficiary form online. It lets you make changes to original PDF content, highlight, black out, erase, and write text anywhere on a page, legally eSign your form, and more, all from one place. Create a free account and use the web to keep track of professional documents.

How do I make edits in hsa beneficiary form without leaving Chrome?

Get and add pdfFiller Google Chrome Extension to your browser to edit, fill out and eSign your hsa beneficiary form, which you can open in the editor directly from a Google search page in just one click. Execute your fillable documents from any internet-connected device without leaving Chrome.

Can I create an electronic signature for signing my hsa beneficiary form in Gmail?

Use pdfFiller's Gmail add-on to upload, type, or draw a signature. Your hsa beneficiary form and other papers may be signed using pdfFiller. Register for a free account to preserve signed papers and signatures.