HSA - Health Savings Account

Health Savings Account - HSA: for staff currently on the Hayward School District health insurance plan with Health Partners.

It is now time to indicate if you would like to make deduction changes or to have additional money taken from your 2018 payroll to fund your HSA.  We need a form completed by each employee enrolled in the District Health Plan for the 2018 calendar year deductions.  Your 2017 form will no longer be valid and will be updated with this form.  Remember that this is in addition to the amount the District has/will contribute for the 2017-18 school year.  Please keep these amounts in mind when figuring your maximum contribution.

District contribution for those on the District HDHP with a Single plus one or Family plan: 

10 Month Employees                                     12 Month Employees

September 15 - $275                                      July 15 - $275

December 15 - $275                                       October 15 - $275

March 15 - $275                                             January 15 - $275

June 15 - $275                                              April 15 - $275

District contribution for those on the District HDHP with a Single plan:

10 Month Employees                                     12 Month Employees

September 15 - $137.50                                 July 15 - $137.50

December 15 - $137.50                                  October 15 - $137.50

March 15 - $137.50                                        January 15 - $137.50

June 15 - $137.50                                          April 15 - $137.50

Please make sure you have answered all the questions, sign and date the form and return it to me by November 30th.  Please contact Sheila Turnbull if you would like a paper form sent to you. 

2018 Employee HSA Payroll Deduction Form

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