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Health Savings Account (HSA) Contribution Form - HSA Bank 2026

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The document is a Health Savings Account (HSA) Contribution Form that provides instructions for submitting contributions via mail or online. It includes sections for accountholder information and contribution details, emphasizing the importance of including the account number on checks and noting deadlines for prior year contributions. The form also offers contact information for assistance and transaction monitoring.

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Click ‘Get Form’ to open the Health Savings Account (HSA) Contribution Form in the editor.
Begin by filling out the ACCOUNTHOLDER INFORMATION section. Enter your first name, middle initial, last name, street address, city, state, ZIP code, and account number. Ensure that you include your Social Security Number as required.
Next, move to the CONTRIBUTION INFORMATION section. Specify the contribution for which you are making this deposit and enter the contribution amount in dollars.
Indicate the source of your contribution by selecting one of the options: Accountholder and/or family member, Employer, or Employee pre-tax (through Section 125 Plan).
Select whether this contribution is for the current year or a prior year by entering the appropriate year in 'yyyy' format. Remember that prior year contributions must be received by April 15 of the following year.
Review all entered information for accuracy before saving your form. Once completed, you can print it directly from our platform or download it for mailing along with your contribution check.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is there a form for HSA contributions?

File Form 8889 to: Report health savings account (HSA) contributions (including those made on your behalf and employer contributions).

What tax documents do I get from HSA Bank?

What tax documents will I get from HSA Bank? You may get both a 1099-SA and 5498-SA from us. IMPORTANT: You wont receive this form if you didnt take a distribution from your HSA in the prior year.

Do I need to report HSA contributions on my tax return?

Tax-deductible HSA contributions should be reported on Form 8889, Health Savings Accounts (HSAs) and filed with your Form 1040 or Form 1040NR. If you or your employer have made contributions to your HSA plan, make sure you reap the benefits on your tax return when you file.

What is a 5498 form for HSA?

The IRS Form 1099-SA is used for reporting HSA distributions; the IRS Form 5498-SA is used for reporting contributions. If you did not have contributions during the year, then you will not see the IRS Form 5498-SA. Although HSAs have triple-tax advantages, you are required to report distributions to the IRS.

How do I report HSA contributions on my W-2?

Box 12 of your W-2 shows your HSA contributions made by pretax payroll deduction, if applicable, and by your employer (labeled employer contributions and marked with code W). Enter the amount from Box 12 on your W-2 on line 9 on Form 8889.

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