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Health Savings Account (HSA) EMPLOYEE CONTRIBUTION FORM

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The maximum contribution for employees whose coverage started January 1 Single 3 400 county contribution 650 / Family 6 750 county contribution 1 300 Employees age 55 and up may contribute an additional 1 000 as Catch-Up contributions. Employee s Signature Date PLEASE MAKE A COPY FOR YOUR RECORDS BEFORE SENDING YOUR FORM TO EMPLOYEE BENEFITS. Employee Benefits Sign-Off Date 2017 HSA Contribution Change Form. For Benefits Staff Use Only Effective Date // Key Bank Monthly Deduction Health Savings ...

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Is there a form for HSA contributions?

IRS Form 8889 is used to report HSA contributions, distributions and your tax deductions. You will complete this form using IRS Forms 1099-SA and 5498-SA provided by HSA Bank.

How does an employer contribute to an employee HSA?

Employers can contribute to HSAs in one of two ways: either with or without a Section 125 plan. An IRS Section 125 plan is sometimes called a cafeteria plan. These programs have menus of benefits that employees can choose from, the same way youd choose items at a cafeteria.

Where do I get form 8889?

Go to .irs.gov/Form8889 for instructions and the latest information. Name(s) shown on Form 1040, 1040-SR, or 1040-NR Social security number of HSA beneficiary.

Do employer HSA contributions need to be reported on W-2?

Employer contributions (including an employees contribution through a cafeteria plan) are allowed to be made to an employees HSA. Generally, employer contributions are excluded from an employees income. Employer contributions are reported on Form W-2, Box 12 using code W.

How do I report my employer contribution to HSA?

payroll deductions for HSA and employer matching contributions for the same tax year are to be reported in box 12 code w on that years w-2.

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