Get the free Employee HSA Payroll Deduction Form (HealthEquity)
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Employee HSA Payroll Deduction Form (HealthEquity)
Return completed forms to:
BSC Human Resources
900 Arkadelphia Road
Box 549090
Birmingham, AL 35254HSA Contribution Limits
2019 Annual HSA Contributions
Single
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How to fill out employee hsa payroll deduction
How to fill out employee hsa payroll deduction
01
Obtain the necessary forms from your employer or human resources department.
02
Fill in your personal information, including your name, address, and Social Security number.
03
Indicate the amount you would like to contribute to your HSA payroll deduction.
04
If applicable, specify any additional instructions or requests regarding your HSA deduction.
05
Review the completed form for accuracy and completeness.
06
Sign and date the form.
07
Return the form to your employer or HR department for further processing.
Who needs employee hsa payroll deduction?
01
Any employee who is enrolled in a high-deductible health plan (HDHP) and wishes to contribute to a health savings account (HSA) can benefit from having an employee HSA payroll deduction. This allows the employee to set aside pre-tax funds directly from their paycheck into their HSA, which can then be used to pay for qualified medical expenses now or in the future.
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