Guiding you from account opening through ongoing management
Account Set-up and Maintenance Forms for Health Savings Accounts
- Beneficiary Change Form: Add or change beneficiary information on your HSA.
Contribution Forms for Health Savings Accounts
- Health Savings Account Deposit Form: Make contributions by check.
HSA Transfer/Rollover Forms
- Health Savings Account Request for Transfer Form: Transfer your existing HSA with another financial institution to First American Bank.
- Health Savings Account Rollover Review Form: Transfer funds from an existing HSA. (Restrictions may apply)
- Health Savings Account Tax Form Correction Request: Request changes to your tax forms 1099-SA, 5498-SA, and/or if you have recognized an error to a prior year contribution.
- Sample HSA Payroll Deduction Authorization Form
Qualified Medical Expenses
- Please refer to IRS Publication 502 here
|Minimum Deductible||2019: $1,350
|Maximum Out-of-Pocket||2019: $6,750
|Contribution Limit||2019: $3,500
|Catch-up Contribution (55 or older)||2019/20:
Frequently Asked Questions
Deductibles and out-of-pocket expenses index annually, adjusting for inflation. All qualified medical expenses are used to reduce the plan's deductible, before the insurer starts paying claims (preventive care excluded). HSAs help reduce the overall cost of the plan's deductible due to their tax advantages and long-term savings/potential growth.
These amounts index annually, adjusting for inflation.