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- (HSA) Contribution Election Change Form - Human Resources ...
Get (HSA) Contribution Election Change Form - Human Resources ...
Requested Effective Date for the Deduction Change: (Enter the first day of the requested month.) Requested Annual Election Pledge: $ (Total amount you want to elect for this calendar year. To stop deductions, enter $0) Requested Bi-Weekly HSA Pre-tax Deduction Amount: $ (Divide the annual amount you wish to contribute by number of remaining pay periods, to calculate your bi-weekly deductions.) Is this a One-time Deduction: Yes No ACS Mell.
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IRS FAQ
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Employer contributions to your Health Savings Account are reported on Form W-2 Wage and Tax Statement, Box 12 with a code "W." An amount entered here will flow to Line 7, Column C of California Schedule CA. The amount is then added to the income total on Line 16 of California Form 540.
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Health Savings Account (HSA) You will receive the IRS Form 1099-SA and IRS Form 5498-SA either by mail or electronically (based upon your elected delivery preference). These IRS tax forms are also available in the Member Website. IRS Form 1099-SA is provided for each HSA distribution you made in the current tax year.
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You can check your HSA balance by visiting the Member Website, where you will have secure, 24/7 access to your account balances and transaction history.
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The 5498-SA form reports all contributions to your HSA for the prior year, including those contributed between Jan. 1 and the tax filing deadline of the current year. It also reports your HSA balance as of Dec. 31 of the prior year.
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Health Savings Accounts: An HSA election change can occur at any time, for any reason. An employer may limit changes to once per month for administrative purposes. However, there are no other restrictions on changing your pre-tax HSA elections.
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Usually, your HSA contribution is reported in box 12 of your W-2 with the code W (Company Contributions to Health Savings Account). TurboTax automatically records this amount in the 1099-SA, HSA, MSA section. Code W reports the combined HSA contributions from you and your employer.
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