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BENEFICIARY DESIGNATION FORMAccount Holder Information (Please Print)Spending Account ID #S Last NameFirst NameMiddle InitialASocial Security # (if SA# is not known)Street Address CityAccount Holder

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How to fill out hsa beneficiary designation form

01

To fill out the HSA beneficiary designation form, follow these steps:

02

Obtain a copy of the form from your HSA provider.

03

Start by entering your personal information, including your name, address, and contact details.

04

Identify your HSA account number and provide it on the form.

05

List the primary beneficiary or beneficiaries. These are the individuals who will receive the HSA funds upon your death.

06

Indicate the percentage or amount you wish to allocate to each primary beneficiary.

07

If you want to designate any contingent beneficiaries, provide their information as well. Contingent beneficiaries will only receive the HSA funds if the primary beneficiaries have predeceased you.

08

Review the completed form for accuracy and sign it.

09

Submit the form to your HSA provider as per their instructions.

Who needs hsa beneficiary designation form?

01

Any individual who has a Health Savings Account (HSA) may need to fill out an HSA beneficiary designation form. It is important to designate beneficiaries to ensure that your HSA funds go to the intended recipients upon your death. Without a designated beneficiary, the distribution of your HSA funds may be subject to probate proceedings or state laws.

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What is hsa beneficiary designation form?

The hsa beneficiary designation form is a form used to specify who will receive the funds in a Health Savings Account (HSA) in the event of the account holder's death.

Who is required to file hsa beneficiary designation form?

Anyone who has a Health Savings Account (HSA) is required to file a beneficiary designation form.

How to fill out hsa beneficiary designation form?

To fill out the hsa beneficiary designation form, the account holder must provide the name, relationship, and contact information of the designated beneficiary.

What is the purpose of hsa beneficiary designation form?

The purpose of the hsa beneficiary designation form is to ensure that funds in a Health Savings Account (HSA) are distributed according to the account holder's wishes.

What information must be reported on hsa beneficiary designation form?

The hsa beneficiary designation form must include the name, relationship, and contact information of the designated beneficiary.

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