Get Health Savings Account (hsa) Employee Contribution Form

Filling out the Health Savings Account (HSA) EMPLOYEE CONTRIBUTION FORM online can be a straightforward process. This guide provides clear and supportive instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to obtain the necessary form and open it in the editor.
2. Enter your name in the 'Employee’s Name' field. Ensure you provide your full name, printed clearly.
3. Fill in your Employee number in the designated field, as it is required for identification.
4. Complete the 'Department & Division' section by specifying your work department and division.
5. Provide your daytime phone number in the 'Work # or Daytime Phone' field to ensure easy communication if needed.
6. Indicate your 'Twice-Monthly Contribution Amount' by typing the specific dollar amount you wish to contribute to your HSA.
7. Be aware that any contribution changes will take effect on the first paycheck of the month. Your form must be submitted at least two weeks prior to this date.
8. Review IRS annual maximum contribution limits for HSA accounts based on your coverage type and age. Ensure your contribution does not exceed these limits.
9. Sign and date the form at the bottom to authorize the withholding of the indicated contribution amount for your HSA.
10. Make a copy of the completed form for your records before submitting it to Employee Benefits.
11. Submit the completed form to Employee Benefits for processing.

Complete your Health Savings Account (HSA) EMPLOYEE CONTRIBUTION FORM online today to ensure your contributions are set accurately.