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HSA Forms

Account Set-up and Maintenance Forms for Health Savings Accounts:

Contribution Forms for Health Savings Accounts:

Transfer/Rollover Forms:

Miscellaneous Forms:

 

 

Contribution Limits

Limits
Single
Family

Minimum Deductible

2019: $1,350
2020: $1,400

2019: $2,700
2020: $2,800

Maximum  Out-of-Pocket

2019: $6,750
2020: $6,900

2019: $13,500
2020: $13,800

Contribution Limit

2019: $3,500
2020: $3,550

2019: $7,000
2020: $7,100

Catch-up Contribution (55 or older)

2019/20:
$1,000

2019/20:
$1,000

 
 HSA Calculators
 

Apply for HSA

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