Get the free Health Savings Account (HSA) Designation or Change of Beneficiary Form

This form allows HSA owners to designate or change beneficiaries for their Health Savings Account, outlining the rules and procedures for beneficiary designations.

How to fill out health savings account hsa

How to fill out Health Savings Account (HSA) Designation or Change of Beneficiary Form

1. Obtain the Health Savings Account (HSA) Designation or Change of Beneficiary Form from your HSA provider.
2. Fill in your personal information, including your name, address, and account number at the top of the form.
3. Specify the primary beneficiaries by providing their names, relationship to you, and percentages of the account they will receive.
4. If applicable, list contingent beneficiaries in the same manner as primary beneficiaries.
5. Review the information for accuracy to ensure that all names and relationships are correctly stated.
6. Sign and date the form to validate your designation or changes.
7. Submit the completed form to your HSA provider according to their instructions, which may involve mailing, faxing, or submitting online.

Who needs Health Savings Account (HSA) Designation or Change of Beneficiary Form?

1. Individuals who have a Health Savings Account (HSA) and wish to specify or change the beneficiaries of their account in the event of their death.

People Also Ask about

What is a beneficiary designation for employee insurance?

Important Things to Remember about Designations Only the insured can sign the designation of beneficiary. Exception: If you assigned your insurance (using an RI 76-10 Assignment form), only the assignee(s) has(have) the right to make a designation. Your employing office must receive the completed form before you die.

How do I know if I am a beneficiary on an account?

To find out whether you are a beneficiary on a deceased person's bank account, you generally will need to present a certified copy of the account owner's death certificate and your government-issued ID to their bank.

What is a beneficiary designation for an HSA?

In the event of your death, your beneficiary will need to complete and return the HSA Beneficiary Account Distribution Form before the funds in your HSA can be transferred to them. They can find this form on the member website or they can call the Customer Care Center to have one sent to them.

Who do I put for beneficiary designation?

Your beneficiary can be a person, a charity, a trust, or your estate. Almost any person can be named as a beneficiary, although your state of residence or the provider of your benefits may restrict who you can name as a beneficiary. Make sure you research your state's laws before naming your beneficiary.

Who is the beneficiary of an HSA?

First, let's talk about what a beneficiary is. It's the person or legal entity who will receive your HSA funds when you pass away.

How do I change my beneficiary designation?

There would be no tax advantages in leaving the assets in the account to a trust account. The trust would incur immediate tax liability on the fair market value of the HSA for any funds left to the trust. If one has charitable organizations they want to support, they can name them as beneficiaries.

For pdfFiller’s FAQs

What is Health Savings Account (HSA) Designation or Change of Beneficiary Form?

The Health Savings Account (HSA) Designation or Change of Beneficiary Form is a document that allows an account holder to designate or update a beneficiary who will receive the funds in the HSA upon the account holder's death.

Who is required to file Health Savings Account (HSA) Designation or Change of Beneficiary Form?

Any individual who holds a Health Savings Account (HSA) and wishes to designate or change the beneficiary of that account is required to file this form.

How to fill out Health Savings Account (HSA) Designation or Change of Beneficiary Form?

To fill out the form, the account holder must provide their personal information, including their name and HSA account number, and specify the name(s) of the new beneficiary(ies) along with their relationship to the account holder.

What is the purpose of Health Savings Account (HSA) Designation or Change of Beneficiary Form?

The purpose of the form is to ensure that the account holder's HSA funds are distributed according to their wishes after their death, providing peace of mind and clarity in beneficiary designations.

What information must be reported on Health Savings Account (HSA) Designation or Change of Beneficiary Form?

The form must include the account holder's identification details, the names and contact information of the beneficiaries, their relationship to the account holder, and any relevant signatures or dates required by the financial institution.