HSA Eligibility Disclosure

HSA eligibility requirements disclosure

• HSAs are never taxed at a federal income tax level when used appropriately for qualified medical expenses. Most states recognize HSA funds as tax-free with very few exceptions. Members should consult a tax advisor regarding their state’s specific rules.

• It is the member’s responsibility to ensure eligibility requirements as well as if they are eligible for the plan and expenses submitted. One should consult a tax advisor as individual factors and situations vary.

When requesting to enroll in an HSA/FSA plan, you agree:

" I acknowledge that by selecting a HealthEquity HSA, I authorize my health plan and other medical, dental and vision providers to provide claim information for myself and all dependents to HealthEquity. I understand that I may be required to submit a HIPAA Release Form to view detailed claim information for my dependents in the HealthEquity member portal."

To be eligible to contribute to an HSA, you must meet the following criteria:

1. Are covered under an HDHP.

2. Are not covered under any other non-HDHP health coverage. Disqualifying examples of coverage include: • Medicare coverage • Coverage under a spouse’s or parent’s health insurance coverage • Access to a flexible spending account (FSA) • Access to a health reimbursement arrangement (HRA) which covers predeductible medical expenses • TRICARE coverage

3. Have not received any medical benefits (excluding dental, vision or preventative) during the previous three months from: • The Indian Health Service (IHS) • The US Department of Veterans Affairs (VA) except for treatment for a serviceconnected disability

4. Cannot be claimed as a dependent on someone else’s tax return. For additional detail regarding HSA eligibility requirements, see the following websites: www.HealthEquity.com/learn/how-an-hsa-works | www.irs.gov/publications/p969