Get Health Savings Account Payroll Deduction Form - Utah State ... - Usu

Filling out the Health Savings Account Payroll Deduction Form is essential for people seeking to manage their healthcare expenses effectively. This guide will provide clear instructions to navigate through the form and ensure that you complete it accurately.

Follow the steps to complete the Health Savings Account Payroll Deduction Form.

1. Press the ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Fill in your personal information. Provide your full name in the 'Employee Name' field, followed by your 'Employee A#', your address, city, state, and zip code.
3. Complete the contact details section by entering your email address, home phone number, and work phone number.
4. Indicate whether you are replacing an existing deduction, establishing a new payroll deduction, or cancelling a current deduction by selecting the appropriate option.
5. In the 'Contribution Amounts' section, specify the date you want your contributions to begin, keeping in mind that the form must be submitted ten days prior to the first payroll deduction.
6. Enter the amount you wish to contribute for each pay period in the designated field.
7. Review the annual contribution limits outlined in the form. For the year 2009, the limit is $3,000 for single coverage and $5,950 for family coverage, with a catch-up contribution of $1,000 available if eligible.
8. Authorize Utah State University to deduct the specified contributions from your paycheck by reading and signing the authorization statement, followed by entering the date of your signature.
9. Mail or hand deliver the completed form to the Human Resources department at Utah State University using the address provided. Ensure to check the contact details for any queries you may have.
10. After completing the form, you can save your changes, download a copy for your records, print the form for physical submission, or share it with relevant departments.

Start filling out your Health Savings Account Payroll Deduction Form online today to manage your healthcare savings effectively.