If you are insured under a federally-qualified High Deductible Health Plan (HDHP), you may be eligible to contribute to a Health Savings Account (HSA).  The HSA rules are governed by IRC§223; please consult your tax advisor.  For additional information, you may also wish to Download IRS Publication 969.

Our preferred HSA vendor is HSABank™.
Click here to complete an on-line new account application.
NOTE: This provides a direct link to the bank’s website; it is the least expensive and quickest method to set up your HSA account.

Click here to download a new account form to set up your HSA
NOTE: This is an Adobe Acrobat form which you must fill out on-line, then print & sign.

Click here to download and print an Account Custodial Agreement

CONTRIBUTIONS:

• All qualified HSA deposits are tax deductible!
  This may be done on your year-end tax filing (Form 1040) or as a pre-tax payroll deduction through your employer’s cafeteria plan.
• For self-employed persons (including partners, S-corp, etc.) there is no net income or “profit” requirement as there is with an IRA.
• You are allowed to contribute in to your HSA up to 1/12th of the calendar year deductible on your HDHP for each full month your were covered under your HDHP.  You are not allowed to contribute to your HSA if you are also covered under any other medical insurance plan which is not a HDHP.
• If you or your spouse are between ages 55 – 65, there is an additional “catch-up” contribution of $500 ($1000 if both are 55 – 65) for 2004.  This amount is prorated for the number of months you are between those ages.
• Eligible contributions for the previous year may be made up until the earlier of April 15th or the filing date of your Form 1040.  The HSA must be established however, by December 31st of the year for which you wish to contribute.

WITHDRAWLS:

• You may withdraw funds from your HSA for any qualified healthcare expense (IRS§213d) that is un-reimbursed by insurance, and incurred on or after the effective date of your HSA & HDHP.
• You may also withdraw funds from your HSA to pay COBRA premiums,  Long-Term Care Insurance premiums, or Medicare Part B.
• Withdrawls for any of the above are income tax free!

Click here to download the IRS Publication 502, which describes qualified healthcare expenses.

Click here to download and print an HSABank Contribution & Withdrawl form.