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Health Savings Accounts (HSA)

A Health Savings Account (HSA) is a tax-advantaged savings account that allows you to set aside money on a pre-tax basis for out-of-pocket qualified medical expenses incurred once the account is open. This account offers triple tax savings by allowing pre-tax contributions, tax-free interest and investment earnings, as well as tax-free distributions when used for qualified medical expenses.

If you want to make an ongoing contribution to your HSA, complete the HSA certification form and follow the instructions on the document

Make an HSA contribution out of your paycheck

HSA overview

Learn more about your HSA plan’s bank, eligibility, contribution limits, and what types of expenses are covered.

If you’re on a University health care plan, HSA Bank will be your HSA administrator.

To contribute to an HSA, you must be enrolled in the YOUR HSA-Eligible Plan and meet the following IRS eligibility criteria:

  • Employee is not covered by any other health plan, including spousal health insurance, except for that the IRS permits.
  • Employee cannot be enrolled in any part of Medicare, Tricare, Medicaid or state health care programs.
  • Employee cannot elect or be covered by another person’s Health Care Flexible Spending Account or Health Reimbursements Arrangement for current plan year.
  • Employee will not be claimed as a dependent on another person’s tax return for current plan year.
  • Employee has not received Veteran’s Administration health benefits in the past 90 days. Only preventative, dental and vision is permitted.
  • The maximum amount that you may contribute to your HSA is dependent on your health plan coverage:
    • Single Coverage: $3,600 per plan year
    • Coverage Including Dependents: $7,200 per plan year

    Employees age 55 or older, may contribute an additional $1,000 to their HSA in 2021.

  • You may change your HSA annual contribution election at any point throughout the year by filling out the HSA contribution form; no qualifying event is needed.
  • Unused funds in your account at the end of the year will roll over to the next year.

Eligible full-time faculty, staff, earning less than $62,100 (salary band 1) and residents and fellows will receive a one-time contribution of $200 (for single) or $400 (for all coverage levels other than single) to their HSA from the University. This amount will be prorated for those that enroll after January 1.

Employees must enroll in the YOUR HSA-Eligible Plan and certify their HSA eligibility on HRMS or by using the HSA Certification form to receive University funding

You may use your HSA to pay for qualified medical, dental, and vision expenses. A complete list of qualified expenses can be found in IRS Publication 502. You can also watch this helpful video.

When you enroll in an HSA, your HSA administrator will send you an HSA card to use at point-of-sale, but you also have the option to request a reimbursement online.

The CARES (Coronavirus Aid Relief and Economic Security) Act, passed by Congress, has expanded covered expenses that you may use your HSA on. The act is retroactive as of 1/1/2020. Qualified expenses now include: over-the-counter medicine without needing a doctor’s prescription and all feminine hygiene products.

HSA contribution form
Complete this form if you are enrolling into your HSA, updating your annual contribution to your HSA, or certifying your HSA eligibility.

HSA Bank contribution form
Complete this form if you would like to contribute to HSA Bank (Excellus BCBS members) outside of the contributions that are deducted from your University of Rochester paycheck.

HSA Bank death beneficiary form
Complete this form if you would like to add or update a Beneficiary(ies) to your HSA Bank account (Excellus BCBS members).

HSA Bank direct transfer request form
Complete this form to authorize HSA Bank to receive a transfer of assets directly from a Health Savings Account (HSA) into your HSA at HSA Bank.

HSA Bank rollover request form
Complete this form for an HSA Rollover involving a check.

HSA Bank name change request form
Complete and remit this form if requesting a name change. Required: Please attach supporting documentation of the name change such as a copy of a marriage certificate, divorce decree, or a court order for the name change.

If you need additional forms, you can contact us or explore our employee benefit forms page.

HSA accounts are set up similarly to bank accounts, which means your HSA account with PayFlex will remain in your name and available for you to spend down on qualified medical expenses throughout your lifetime. You may have both your PayFlex and HSA Bank accounts active at the same time. Employees who choose to keep their account with PayFlex, will incur a monthly fee for their account as of January 2021.

You can continue to contribute to your PayFlex account, but only on a post-tax basis since the University will no longer be connected to PayFlex. If you would like to contribute pre-tax to an HSA, you can elect an annual contribution amount at anytime for an account with HSA Bank.

Employees who would like to transfer their PayFlex HSA account to their new HSA Bank account will need to fill out the HSA Bank Form and submit directly to PayFlex at:

Fax: 402-943-1567


PayFlex Systems USA, Inc. as Custodian for (Name of Account Owner) HSA Operations
PO Box 3317
Carol Stream, IL 60132-3317

Employees that elect this action can expect a $25 close account fee per PayFlex policies and potentially blackout dates on accessing their funds as the transfer from PayFlex to HSA Bank is completed. Specific questions about transferring funds should be directed to HSA Bank (1-866-471-5940) and PayFlex (1-844-729-3539).

Information on administrative fees can be found online by signing into your account at and clicking on “View fee schedule” under Manage Funds or by contacting PayFlex at 1-844-729-3539.

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