Deposit slips, forms and information about investment options.
Eligibility for HSA
You must participate in a High Deductible Health Plan, have no other insurance coverage other than those specifically allowed, and not be claimed as a dependent on someone else's tax return in order to be eligible for an HSA. Some examples of other coverage that would cause ineligibility are: a health care flexible spending account (HCFSA), a spouse's FSA, a spouse's family enrollment in an HMO, other non-high deductible health insurance coverage, TRICARE, Medicare, or receipt of VA benefits within the previous three months. You can still have other disability, dental, vision and long-term care insurance policies.
Aetna HealthFund® HSA Savings Calculation Tool – An interactive calculator to help you discover the savings opportunity and tax advantages associated with an HSA.
Qualified Expenses Under Your HSA – You may use your HSA for qualified expenses as allowed by the IRS. Some expenses may not be covered by your health benefits plan but are considered "qualified expenses" for payment with your HSA dollars. If you use your HSA for IRS qualified expenses that are not covered by your health benefits plan, that amount will not apply to you plan deductible.
Important HSA Information and Forms
- HSA Deposit Slip (PDF)
- Electronic Funds Transfer Authorization (EFT) - Completed on the Employee Portal in the “Link my Bank Accounts” section.
- Beneficiary Designation Form – or can also be completed online in Employee Portal
- Health Savings Account Custodial Agreement (PDF)
- Health Savings Account Fee Descriptions (PDF)
- Transfers from another HSA to your Aetna HSA - HSA Trustee Transfer Form (PDF)
- Request to Rollover/Transfer IRA Funds to your Aetna HSA - HSA Trustee Transfer Form (PDF)
- HSA Return of Excess Contribution or Opened in Error Closure Form (PDF)
- HSA Investment Service Description (PDF)
- HSA Investment Choices (PDF)
- HSA 2018 Contribution Limits (PDF)
- HSA 2017 Contribution Limits (PDF)
- Request to Close (PDF)
- Debit Card or Check Information – Checkbooks are no longer an option. Checks can be electronically created on the Employee Portal and sent directly to a provider. Additional debit cards can be requested by calling PayFlex customer service or on the Employee Portal.