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This form is used by employees to authorize payroll deductions for their Health Savings Account (HSA) contributions, including employer contributions and catch-up contributions for eligible individuals.
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How to fill out employee hsa payroll deduction

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How to fill out Employee HSA Payroll Deduction Form

01
Obtain the Employee HSA Payroll Deduction Form from your HR department or company's website.
02
Fill in your personal information, including your name, employee ID, and department.
03
Specify the amount you wish to contribute to your HSA from each paycheck.
04
Indicate whether the contribution is pre-tax or post-tax.
05
Review any employer contributions and enter them if applicable.
06
Sign and date the form to confirm your authorization.
07
Submit the completed form to your HR department or payroll administrator.

Who needs Employee HSA Payroll Deduction Form?

01
Employees who wish to contribute to a Health Savings Account (HSA) through payroll deductions.
02
Individuals who are eligible for an HSA and want to take advantage of tax benefits and savings for healthcare costs.
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People Also Ask about

These payroll deductions are not subject to federal income tax, Social Security or Medicare (FICA) taxes or most state income taxes. Generally, employees can start, modify or stop HSA contributions at any time during a year. Employers can make contributions directly to their employees' HSAs.
Employer contributions are tax-deductible as the IRS considers them a business expense. Employers avoid the comparability rules for HSA contributions.
File Form 8889 to: Report health savings account (HSA) contributions (including those made on your behalf and employer contributions). Figure your HSA deduction. Report distributions from HSAs.
Payroll deduction allows you to have contributions taken directly from your paycheck. The funds are deducted pre-tax through your employer's Section 125 Plan. You may change or stop your contribution amount at any time through your employer.
Your annual contribution will be divided into equal amounts and deducted from your payroll before taxes. Direct contributions can also be made from your personal checking account and can be deducted on your personal income tax return.
File Form 8889 to: Report health savings account (HSA) contributions (including those made on your behalf and employer contributions). Figure your HSA deduction.
Yes - Most benefit plans only allow midyear changes if you have a qualifying event, but HSAs are different. If you need to change your HSA contribution amount at any point during 2025, you can do so by submitting an HSA Contribution Change event in Workday.
If you contribute money to your HSA through your paycheck, you can not deduct the contributions on your tax return. However, if you contribute dollars to the account directly — meaning, without going through your employer's payroll department — you can deduct the contributions on your tax return for the year.

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The Employee HSA Payroll Deduction Form is a document that allows employees to request payroll deductions to be contributed to their Health Savings Account (HSA).
Employees who wish to make contributions to their HSA directly from their payroll are required to file the Employee HSA Payroll Deduction Form.
To fill out the Employee HSA Payroll Deduction Form, employees need to provide their personal information, specify the amount they wish to contribute per pay period, and sign the form to authorize the deduction.
The purpose of the Employee HSA Payroll Deduction Form is to facilitate the automatic contribution of funds to the employee's HSA from their paycheck, simplifying the process of saving for qualified medical expenses.
The information that must be reported on the Employee HSA Payroll Deduction Form includes the employee's name, Social Security number, payroll deduction amount, contribution frequency, and the employee's signature.
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