Eligibility for HSA
You must participate in a qualified High Deductible Health Plan (HDHP). You also can’t be enrolled in Medicare, Medicaid or Tricare, be someone else’s tax dependent, or have any non-permitted coverage.
Some examples of non-permitted coverage are:
- You can’t have other health coverage that pays for out-of-pocket health care expenses before you meet your plan deductible.
- You or your spouse can’t have an active health care Flexible Spending Account (FSA) or Health Reimbursement Account (HRA) in the same year.
Qualified Expenses Under Your HSA – You may use your HSA for qualified medical expenses as allowed by the IRS for you, your spouse or your tax dependents. This includes what you pay for deductibles, co-insurance and copays. Some expenses may not be covered by your health benefits plan but are considered "qualified expenses" for payment with your HSA dollars. If you use your HSA for IRS qualified expenses that are not covered by your health benefits plan, that amount will not apply to your plan deductible.
Important HSA Information and Forms
- HSA Deposit Slip (PDF)
- Electronic Funds Transfer Authorization (EFT) - Completed on the Employee Portal in the “Link my Bank Accounts” section.
- Beneficiary Designation Form (PDF) – or can also be completed online in Employee Portal
- Health Savings Account Custodial Agreement (PDF)
- Health Savings Account Fee Descriptions (PDF)
- H.S.A Transfer Form (PDF)
- HSA Return of Excess Contribution or Opened in Error Closure Form (PDF)
- HSA Investment Service Description (PDF)
- HSA 2022 Contribution Limits (PDF)
- HSA 2021 Contribution Limits (PDF)
- Debit Card or Check Information – Checkbooks are no longer an option. Checks can be electronically created on the Employee Portal and sent directly to a provider. Additional debit cards can be requested by calling PayFlex customer service or on the Employee Portal.