Hi,

We are offering a new HSA program at work this year and Bank of America has not provided us with a Salary Reduction Form (for employees to complete authorizing contributions directly from his/her paycheck to their HSA).

Does anyone have a sample form that I could look at before I take a stab at creating my own?

Thanks so much.

Wouldn't the use of a SRA specifically for the HSA conflict with the cafeteria plan SRA ? In other words shouldn't it be a additional line item on the existing SRA ? Have you amended your PD to include an HSA and HDHP ?

The FSA accounts are currently managed by a different company -- not Bank of America, who will be managing our new HSA. We are starting an HDHP in January.

Shouldn't we be using a separate SRA for the contributions to the Bank of America run HSA?

(this may be a stupid question...but what is a PD?)

rbk - the salary reduction form is a internal payroll form. You should be able to use the same form for all benefits, regardless of who the deductions are sent to after they are withheld. That is function of you accounting system.

PD is plan doc

I see. I think the question came up because the FSA Enrollment Form also acts as the SRA, but we have a different SRA for our 403(b) plan.

Thanks.

So what do you use for the employee share of the health and dental etc ?

It's on the enrollment form from the benefit management company.

Our employees are going to be automatically enrolled in the HSA when they enroll in the HDHP -- that's why I need a separate form.