[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-301269-105":3,"detail-sidebar-cat-1-en-105":84,"doc-detail-301269-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":77,"head_meta":79,"extra_data":81,"updated_unix":83},105,"en","hsatoday-take-control-of-your-healthcare-expenses-hsa-account-application-and-beneficiary-designation-form","HSAToday - Take Control of Your Healthcare Expenses - HSA Account Application and Beneficiary Designation Form","","HSAToday provides Health Savings Account (HSA) benefits designed for qualified high deductible health plan participants, including tax-free deposits, tax-free growth, and tax-free withdrawals for eligible healthcare expenses. The account supports tax-free interest, possible investing after meeting a $1,000 threshold, and features such as mySourceCard debit integration, automatic Form 8889 completion, ClaimsVault for digital receipts, and investment management. It also includes an application and beneficiary designation process with required account holder and eligibility information.",{"@graph":14,"@context":76},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/letters/","Letters",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/hsatoday-take-control-of-your-healthcare-expenses-hsa-account-application-and-beneficiary-designation-form/301269/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/hsatoday-take-control-of-your-healthcare-expenses-hsa-account-application-and-beneficiary-designation-form/301269.png","ImageObject",442,249,{"name":42,"@type":43},"Sage","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-24","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":22},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68,72],{"name":59,"@type":60,"acceptedAnswer":61},"What makes an HSA tax-free for healthcare expenses?","Question",{"text":62,"@type":63},"HSAToday describes tax-free coverage for qualified healthcare expenses when you enroll in a qualified high deductible health plan. Deposits, growth, and eligible withdrawals are presented as tax-free benefits.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"How does HSAToday handle tax filing for Form 8889?",{"text":67,"@type":63},"HSAToday is stated to automatically fill out Form 8889 for filing with your personal tax return, based on your HSA details.",{"name":69,"@type":60,"acceptedAnswer":70},"When can I invest money in my HSA?",{"text":71,"@type":63},"The document states that once you reach the $1,000 balance threshold, you can invest pre-tax dollars and obtain tax-exempt returns, managed through the portal.",{"name":73,"@type":60,"acceptedAnswer":74},"What information is required for primary beneficiary designations?",{"text":75,"@type":63},"The form requires each designated person’s address, city, state, zip, social security number (if known), relationship, and a percentage of remaining account value. Percentages must total 100%.","https://schema.org",{"og:url":32,"og:type":78,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":80,"canonical":32},"index,follow",{"doc_id":82,"site_id":7},301269,1790228986,{"code":4,"msg":85,"data":86},"success",[87,92,97,102,107,112,117,121,126],{"id":88,"doc_module":22,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},11,"Presentations",90,"presentations",{"id":93,"doc_module":22,"doc_module_name":25,"category_name":94,"show_sort_weight":95,"slug":96},12,"Resumes",80,"resumes",{"id":98,"doc_module":22,"doc_module_name":25,"category_name":99,"show_sort_weight":100,"slug":101},14,"Invoices",70,"invoices",{"id":103,"doc_module":22,"doc_module_name":25,"category_name":104,"show_sort_weight":105,"slug":106},15,"Posters",60,"posters",{"id":108,"doc_module":22,"doc_module_name":25,"category_name":109,"show_sort_weight":110,"slug":111},16,"Social Media",50,"social-media",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},17,"Forms",40,"forms",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":119,"slug":120},18,30,"letters",{"id":122,"doc_module":22,"doc_module_name":25,"category_name":123,"show_sort_weight":124,"slug":125},21,"Paper Templates",5,"papers-templates",{"id":127,"doc_module":22,"doc_module_name":25,"category_name":128,"show_sort_weight":4,"slug":129},158,"General","general-158",{"code":4,"msg":85,"data":131},{"doc_id":82,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":22,"category_id":118,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":30,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":93,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":33},687197207057,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","|  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |\n|  | Save T | oday | for a H | ealthy | Futur | e ™ |  |  |\n|  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |\n|  |  |  |  | | | | \u003Cbr>|  |\n|  |  |  |  |  |  |  |  |  |\n|  | Tax-Free S | avings | Tax-Fr | ee Contribu | tions | Tax-Free Dis | bursements |  |\n\nTake Control of Your Healthcare Expenses with an HSA  \nTax-Free Deposits | Tax-Free Growth | Tax-Free Withdrawals  \nWhen you enroll in a qualified high deductible health plan, you’re eligible for a Health Savings Account (HSA) . You enjoy lower plan premiums and can set aside money tax-free to cover out-of-pocket healthcare costs.  \nAn HSA:  \n• Covers qualified healthcare expenses tax-free  \n• Earns interest tax-free  \n• Can be invested  \n• Saves you Federal, FICA and State taxes  \n• Stays with you for life  \n• Rolls over from year to year  \n• Reduces insurance premiums paid by you and your family  \nWith an HSA, you have control over:  \n• How much money to put into the account  \n• Whether to save the account for future expenses or pay current medical expenses  \n• Which medical expenses to pay from the account  \n• Whether to invest any of the money in the account and which investments to make  \nYou own the account!  \n(It’s yours, you own it)—You keep your HSA even if you:  \n• Change jobs or become unemployed  \n• Change medical coverage  \n• Move to another state  \n• Change your marital status  \nWith HSAToday®, you can make the most of your account with these features:  \nmySourceCard®  \nHSAToday® is integrated with the mySourceCard® Mastercard® debit card.  \nNever worry about having to pay out-of-pocket and wait for reimbursement. Just swipe it at locations where you are paying for eligible items and services.  \nForm 8889  \nHSAToday® will automatically fill out your 8889 tax form for filing with your personal  \ntax return.  \nClaimsVault®  \nA unique, patented feature of HSAToday® is the ClaimsVault®, which stores digital receipt documentation and certification status that allows for expense substantiation. Your expense information remains available in ClaimsVault for as long as your HSAToday account is open.  \nInvestments  \nOnce you reach the $1,000 balance threshold, you can invest your pre-tax dollars and get tax-exempt returns! Manage every aspect of your HSA investments inside the portal. Choose from several different investment models (picked by our dedicated investor) or select individual funds.  \nApplication and Beneficiary Designation Form  \nPlease complete this form and return to your Plan Service Provider (PSP) indicated on the back of this form.  \nAccount Holder Information (Please Print) *Required Field  \n*Name: (First)   (MI)   (Last)    \n*Preferred Mailing Address: n Home Address n Mailing Address  \n*Home Address:    \n*City:   State:   Zip Code    \n*Mailing Address (if different from above):    \n*City:   State:   Zip Code    \n*Home Phone:   Work Phone:    \nEmail Address:  *Date of Birth:    \n*Social Security Number:    \n*Mother’s Maiden Name (security purposes only):   *City, State of Birth:    \nEmployer Information  \nEmployer Name:    \nAddress:    \nCity:   State:   Zip Code:    \nIs your HSA funded through Cafeteria Plan deductions? Yes n No n  \nEligibility Information (You Must Check Yes On Each Question Below To Be Eligible For An Hsa)  \nn Yes n No I am currently, or will be upon the date of my first contribution, an eligible individual as described in the Custodial Account Agreement.  \nn Yes n No I understand that maintaining my eligibility is my responsibility and that the Custodian will assume that all contributions are made while I am eligible to do so.  \nn Yes n No I am currently, or will be upon the date of my first contribution, covered by a High Deductible Health Plan (HDHP) that meets the qualifications detailed in the Custodial Account Agreement.  \nHDHP Information  \nHDHP Carrier:   Check One: o Single C","cbCaieTHrfrEnYq1","https://ap.wps.com/l/cbCaieTHrfrEnYq1","pdf",1329156,"English","# Application and Beneficiary Designation Overview\n## Tax-Free Benefits and Account Control\n## HSAToday Features (mySourceCard, Form 8889, ClaimsVault)\n## Investments and Eligibility Requirements\n## Account Holder Information\n## Employer and HDHP Information\n## Application Submission Instructions\n## Beneficiary Designation (Primary and Contingent)","[{\"question\":\"What makes an HSA tax-free for healthcare expenses?\",\"answer\":\"HSAToday describes tax-free coverage for qualified healthcare expenses when you enroll in a qualified high deductible health plan. Deposits, growth, and eligible withdrawals are presented as tax-free benefits.\"},{\"question\":\"How does HSAToday handle tax filing for Form 8889?\",\"answer\":\"HSAToday is stated to automatically fill out Form 8889 for filing with your personal tax return, based on your HSA details.\"},{\"question\":\"When can I invest money in my HSA?\",\"answer\":\"The document states that once you reach the $1,000 balance threshold, you can invest pre-tax dollars and obtain tax-exempt returns, managed through the portal.\"},{\"question\":\"What information is required for primary beneficiary designations?\",\"answer\":\"The form requires each designated person’s address, city, state, zip, social security number (if known), relationship, and a percentage of remaining account value. Percentages must total 100%.\"}]","HSAToday - Take Control of Your Healthcare Expenses - HSA Account Application and Beneficiary Designation Form | PDF",1789780552]