2014 Health Savings Accounts Eligibility Worksheet

To be eligible for a Health Savings Account (HSA), you must be covered by a high-deductible health plan (HDHP). Generally, an HDHP is a health plan with:

  • A deductible of at least $1,250 for single coverage
  • A deductible of at least $2,500 for family coverage
  • A maximum annual out-of-pocket expense limit for allowing costs, not exceeding $6,350 for single coverage
  • A maximum annual out-of-pocket expense limit for allowing costs, not exceeding $12,700 for family coverage
Additionally, you must meet the following criteria:
  • You must not be covered by any other health plan other than another HDHP (with limited exceptions)
  • You must not be eligible to be claimed as a dependent on another person's tax return
  • You are not enrolled in Medicare


Eligibility for an HSA is determined by Federal law. It is your responsibility to ensure you are eligible. Please complete the worksheet below to determine if you are eligible.

 

Please answer question
Question Yes No
1. Can you be claimed as a dependent on another person's tax return?
2. Are you enrolled in Medicare?
3. Are you enrolled in a qualified High Deductible Health Plan (HDHP) with a minimum annual deductible of at least $1,250 for single coverage and $2,500 for family coverage for 2014?
4. Do you have additional health coverage under another plan, including a plan maintained by your spouse's or dependent's employer?
If you answered no, proceed to question 6.
5. If you answered Yes to question 4, is this other health coverage an HDHP?
6. Do you have coverage under a health flexible spending account (FSA), including an FSA maintained by your spouse's or dependent's employer?

We're sorry, you do not meet the criteria to be eligible for a Health Savings Account. If you have questions, please consult your insurance provider or tax advisor.
Based on the information you provided, you are eligible for a Health Savings Account. You may apply for a Health Savings Account by completing our online application.
Depending on the type of other health coverage referenced in questions 5 and 6, you may or may not be eligible for an HSA. Please consult your tax advisor.
Depending on the type of FSA referenced in question 6, you may or may not be eligible for an HSA. Please consult your tax advisor.

 

 

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