Get Hsa Payroll Deduction Form 2015.pdf - Center Cass School District 66 - Ccsd66

Filling out the HSA Payroll Deduction Form is a crucial step in managing your health savings account contributions. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and submit it online with confidence.

Follow the steps to complete your HSA Payroll Deduction Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your employee information. Start with the plan year, which should reflect 01/01/2015 through 12/31/2015. Provide your name as it appears on official documents.
3. Enter your home address, including street address, city, state, and zip code. Ensure all information is accurate to prevent issues with processing.
4. Specify the effective date for your contributions on the form.
5. Review the contribution information for the plan year. Note the deductible amounts for single coverage at $2,500 and family coverage at $5,000.
6. Refer to the maximum HSA contributions allowed for 2015, which are $3,350 for an individual and $6,650 for a family. If you are 55 or older, indicate your eligibility for an additional catch-up contribution of $1,000.
7. In the elections section, select one option: either specify the total annual contribution and per pay period amounts, indicate a change to your previous contribution, or decline to contribute.
8. Ensure to sign the form, indicating your request for the payroll deduction as specified. Include the date of signing.
9. Once you have completed all fields accurately, you can save your changes, download, print, or share the form as necessary.

Complete your HSA Payroll Deduction Form online today to manage your health savings account effectively!