*Pending credit approval.

BENEFITS Reduced Insurance Premiums Tax Savings Interest Earning & Long Term Savings Ownership Transportable & Accessible

ELIGIBILITY Enrolled in a HSA‐qualified High Deductible Health Insurance Policy Not covered by any other health plan that is not a HDHP Not claimed as a dependent on another person's tax return Not enrolled in Medicare

HSA LINKS Qualified Medical Expenses Contribution Limits Download HSA Brochure HSA Forms & Documents Health Care Reform & Health Savings

HSA CONTRIBUTION LIMITS:

2013 Year	Minimum Deductible Required**	IRS Maximum Contribution*	Maximum Out-of-Pocket
Self-Only Coverage	$1,250	$3,250	$6,250
Family Coverage	$2,500	$6,450	$12,500
2012 Year	Minimum Deductible Required**	IRS Maximum Contribution*	Maximum Out-of-Pocket
Self-Only Coverage	$1,200	$3,100	$6,050
Family Coverage	$2,400	$6,250	$12,100
* Additional Catch-up Contributions: The catch up amount (for those 55 and older) remains at $1,000 for current and future years. *Contributions can be made as late as Apr.15 of the following year* Note:  Resource Bank is not liable for any excess contributions.  Please use this only as a reference.  For in-depth regulations regarding HSAs, please consult a competent tax advisor.

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HSA FORMS & DOCUMENTS:

HSA FORMS: Please print and complete the forms.  Copies of official identification are required for the account holder and any additional authorized signer(s) on the account.  Forms and identification can be mailed, faxed, or dropped off to any of our locations.  Please contact a Resource relationship banker to make additional arrangements for delivery or any other questions.

1. HSA Application & Designation of Beneficiaries (One form for each employee.)
   

2. HSA Debit Card Application
   

3. HSA Custodial Agreement (One form for each employee.)
   Note: if contributions are made by the EMPLOYER, as either an employee benefit or as a payroll deduction, the EMPLOYER needs to submit a breakdown, through the Employer Contribution Form
   

4. HSA Transfer/Rollover Form
   Note: A transfer is a direct transfer of funds from an existing HSA from one financial institution to another.  A Rollover occurs when you either have an MSA you would like to Rollover into an HSA or you were issued a check from a previous MSA or HSA and want to open a new HSA..
   

5. IRA to HSA Transfer Form

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Healthcare Reform and Health Savings:

Resource Bank and its employees are here to help our customers understand the potential benefits and requirements of a Health Savings Account. While we do our best to inform you of the facts, we are not to be held responsible for your decisions of how HSA funds are used or if you are qualified to open an account.

On March 23, 2010, President Obama signed into law far-reaching healthcare financing legislation. Here are two changes that became effective January 1, 2011:

• Qualified Medical Expenses: Starting January 1, 2011 you will no longer be able to pay for over-the-counter medications from your HSA as a qualified medical expense. Until the end of this year, you can reimburse yourself or pay from your HSA the money used to buy over-the-counter medications. The new law removes over-the-counter drugs not prescribed by a physician from being paid from an HSA (Health Savings Account), FSA (Flexible Spending Account), or HRA (Health Reimbursement Account) on a tax-free basis.
• Non-qualified expense penalty: Under the new law, if you use your HSA funds for non-qualified expenses, you will face a higher penalty. The tax penalty for non-qualified HSA distributions will increase, effective January 1, 2011, from 10% to 20%

Click here for additional information about HSA’s

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