Health Savings Accounts (HSA)

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

• HSA Bank mobile app information
• HSA Bank member website guide
• Note: If you change your address, you will need to update your address on HRMS AND within the HSA Bank Member Portal by following the path Profile > Update Profile > Update the address > Submit.

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: $3,650 per plan year
  • Coverage Including Dependents: $7,300 per plan year

Eligible full-time faculty and staff earning less than $64,000 (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 1st of the plan year.

• 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.

Pre-tax HSA funds can only be used toward the qualified expenses of tax-dependents – if you have a domestic partner that is not your tax dependent, you cannot use your pre-tax HSA funds for them.

2022 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 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.