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HSA Qualification Test

Select Calendar Year:

Answer the following questions to determine if you qualify for an HSA:

1.
Are you covered under a high deductible health plan (HDHP)?

 
Yes No
2.
Does your health plan have an annual deductible of not less than $1,100 per individual and $2,200 per family?
 
Yes No
3.
Does your health plan have an annual out-of-pocket maximum or limit of no more than $5,600 per individual and $11,200 per family?
 
Yes No
4.
Are you covered by Medicare (Part A or Part B)?

 
Yes No
5.
Does another person claim you as a tax dependent on their tax return form?

 
Yes No
6.
Are you covered by a supplemental or cancer plan, discount card or discount price program, employee assistance program (EAP), wellness or disease management program, or insurance for a specified disease or illness?
 
Yes No
7.
Are you covered by another health plan (such as your spouse's plan)-other than those listed in question #6-that is not a high deductible health plan (HDHP)?
 
Yes No
8.
Are you covered by any other health care account, such as a flexible spending account (FSA) or an employer-funded health reimbursement arrangement (HRA), that covers medical expenses in addition to dental and vision expenses?
 
Yes No
 
Do you qualify for a Health Savings Account (HSA)?
Please answer all questions.
Learning Center Links
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 Choosing Between an FSA and HSA
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