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This form is used to request the closure of a Health Savings Account (HSA) with Chase, including instructions for the disbursement of remaining funds.

How to fill out request to close health

How to fill out Request to Close Health Savings Account

1. Obtain the Request to Close Health Savings Account form from your HSA provider.
2. Fill in your personal information, including your name, address, and account number.
3. Indicate the reason for closing the account in the designated section.
4. Review any remaining funds in the account and decide how you want them to be disbursed or transferred.
5. Sign and date the form to certify that you want to close the account.
6. Submit the completed form to your HSA provider, either by mail or through their online portal.

Who needs Request to Close Health Savings Account?

1. Individuals who no longer want or need their Health Savings Account.
2. People who are switching to a different HSA provider.
3. Participants in an HSA who have reached retirement age and wish to close the account.

People Also Ask about

Is there a penalty for closing a health savings account?

If you wish to close your HSA, you may visit the member website and complete a Distribution Request form or you may call one of our customer care representatives at the phone number on the back of your debit card to direct us to close your account.

How do I close out my HSA account?

HSA Closure Fee $25.00 To avoid this fee, keep your account open with HSA Bank and continue to use your HSA funds for eligible expenses.

Can I close my HSA and take the money?

If you close your HSA permanently, you'll often have to pay an account closure fee. This fee can also apply if you rollover your HSA to a new provider. In general, you should only close your account if you're no longer eligible for an HSA and don't want to open one in the future.

Is there a fee to close HSA?

To do this, you must log in to your online account and select “Sell All” for each of the funds that you own. Last name First name M.I. Note: If this closure is due to the death of the account holder, please use the HSA Instructions Upon Death form.

How much does it cost to close an HSA account?

Keep in mind, if you withdraw the remainder of your account when you close your HSA and don't roll over to another HSA or use the dollars for eligible medical expenses, you must report the withdrawals as income on your income tax return and you will owe a 20% additional tax penalty before age 65.

How do I close a HSA account online?

The funds can be withdrawn without an extra penalty. But you'll still have to pay regular income tax on withdrawals made for anything other than a qualified medical expense. Also, once Medicare kicks in, you can use it for certain expenses, such as Part B premiums and Part D prescription drug coverage.

For pdfFiller’s FAQs

What is Request to Close Health Savings Account?

The Request to Close Health Savings Account is a formal document used by account holders to initiate the closure of their Health Savings Account (HSA). It typically includes instructions for the financial institution to liquidate the account and distribute the funds.

Who is required to file Request to Close Health Savings Account?

The account holder of the Health Savings Account is required to file the Request to Close Health Savings Account. This can also include authorized representatives if the account holder is unable to do so.

How to fill out Request to Close Health Savings Account?

To fill out the Request to Close Health Savings Account, the account holder must provide necessary personal information, including their name, account number, and contact details. The form should also specify the reason for closure and how the remaining funds should be disbursed.

What is the purpose of Request to Close Health Savings Account?

The purpose of the Request to Close Health Savings Account is to formally notify the financial institution of the account holder's intent to close the account and manage the distribution of any remaining funds in accordance with applicable laws and regulations.

What information must be reported on Request to Close Health Savings Account?

The Request to Close Health Savings Account must typically report the account holder's name, account number, contact information, closure reason, and instructions for fund distribution, if applicable.