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Complete these five steps to set up your Health Savings Account (HSA). If you are an employee,
you may want to check your employers benefits offerings. For your convenience, detailed
instructions for setting up an HSA
is also available in PDF format. For additional information, see Forms and Information.
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| Step 1. |
Obtain an HSA qualified high deductible health plan (HDHP)**.
The following minimum must apply to all medical expenses:
- Individual Coverage $1,200 for 2010 and 2011
- Family Coverage $2,400 for 2010 and 2011
The sum of annual deductibles and out-of-pocket expenses cannot exceed:
- Individual Coverage $5,950 for 2010 and 2011
- Family Coverage $11,900 for 2010 and 2011
* Minimum deductibles and out-of-pocket expenses are indexed annually.
** Contact your health insurance provider to verify that your plan is a qualified
HDHP.
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| Step 3. |
If you would like a debit card for your dependent, download and complete the
Request for Dependent Debit Card.
There will be a one-time $15.00 fee for each dependent card.
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| Step 4. |
Enclose two checks as described below:
- One-time setup fee $10.00 Payable to AFHSA
- Minimum opening deposit $50.00 Payable to InvesTrust, N.A.
After the establishment of your HSA, there will be a monthly maintenance fee of $5.00 applied to your account.
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| Step 5. |
Mail the Application/Custodial Agreement, and Request
for Dependent Debit Card (if applicable), and your checks to:
American Fidelity Assurance Health Services Administration
P.O. Box 25523, 2000 N. Classen Blvd., G16
Oklahoma City, OK 73125-0523
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When we receive your application and payment we will:
- Set-up your investment account.
- Mail a welcome kit to you 3 - 5 business days after receipt of your application.
- Mail a debit card to you within 7 - 10 business days after we receive your application.
Note: if you do not receive a debit card within the allotted
7-10 day time frame, you have until the 15th business day, following the 10th day, to
report the occurrence. If it is reported after the 15th day, a $15.00 fee will be
charged to issue a new debit card.
For example, if your HSA’s effective date is 06/01/10 and you do not receive your debit
card by 06/10/10, you have until 06/25/10 to contact us so we can issue a new card free
of charge. If it is reported after 06/25/10, the $15.00 fee will apply.
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