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HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENT Please Keep For Your Records The depositor whose name appears on the attached Application is establishing a Health Savings Account under Section 223(a) of

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How to fill out hsa custodial agreement

How to fill out an HSA custodial agreement:

01

Obtain the custodial agreement form from the financial institution that will serve as the HSA custodian. This form is typically available on their website or can be requested directly.

02

Carefully read through the agreement to understand the terms and conditions. Pay close attention to any fees, investment options, contribution limits, and withdrawal rules.

03

Fill in your personal information accurately. This may include your name, address, social security number, and contact details.

04

Specify the type of HSA custodial account you are opening. This could be an individual account, family account, or employer-sponsored account.

05

Designate a beneficiary for your HSA. This is the person who will inherit your HSA funds in the event of your death.

06

Choose the investment options for your HSA funds, if applicable. Some custodians offer a range of investment opportunities, while others may only offer a basic interest-bearing account.

07

Review the contribution limits for the current year and indicate the amount you intend to contribute to your HSA. Keep in mind that these limits may change annually.

08

Familiarize yourself with the list of qualified medical expenses that can be reimbursed from your HSA. It is important to understand what expenses are eligible to ensure proper use of your funds.

09

Sign and date the HSA custodial agreement form. By signing, you acknowledge that you have read, understood, and agreed to the terms and conditions outlined in the agreement.

10

Submit the completed form to the HSA custodian as per their instructions. This may involve mailing the form or submitting it electronically through their online portal.

Who needs an HSA custodial agreement:

01

Individuals who have a Health Savings Account (HSA) and want to establish a custodial account to hold their HSA funds.

02

Employers who offer HSA options to their employees and need to establish an HSA custodial account for their employees.

03

Financial institutions that act as custodians for HSA funds and require individuals to sign a custodial agreement to open an account.

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