Health Savings Accounts are overseen by the IRS.
It is YOUR responsibility to make sure you comply with IRS guidelines regarding contributions and use of your HSA funds.
We recommend speaking to your tax or financial advisor regarding your individual situation.
WHAT IS A HEALTH SAVINGS ACCOUNT (HSA)?
An HSA is different and separate from your insurance. It is an account you set up at a financial institution and it belongs to you during and after your employment with the district. Because deposits into the Health Savings Account are not taxed, the IRS regulates how much you may contribute and how you may spend it. In order to get the tax advantage of an HSA you must be enrolled in a qualified High Deductible Plan (as defined by the IRS). As your account grows, you can also invest the funds or use it for retirement expenses after age 65!
Moda Plans 6 and 7 are the two health insurance options available to employees and retirees that qualify as HSA compliant medical plans. These plans have the highest deductibles.
DO YOU QUALIFY?
You must establish that you are not:
1) Claimed as a dependent on another person's tax return
2) Covered by any other health plan other than a qualified High Deductible Health Plan (HDHP)
3) Enrolled in Medicare
REMEMBER: If you choose Moda plans 6 or 7, you are not finished with your enrollment! You must turn in an HSA enrollment form to payroll.
If you used an HSA account last year, the district will assume you want to contribute to the same account this year. However, if this is the first time you are enrolling in the high deductible plan you may also open a Health Savings Account and turn the enrollment form into the payroll department before the payroll cutoff date. Any district contributions will be forfeited until your HSA enrollment information is received. Employees will not be paid retroactively for months in which the employee was eligible but had not submitted all required documents. You may open an HSA account with American Fidelity, Optum Bank or your own personal bank. If you prefer to open an account with your own bank, you must first visit your bank to open an account, then be sure to complete the appropriate form below for your payroll office.
HOW IT WORKS:
Employees may select the Moda Plans 6 or 7 with or without dental and/or vision. If the combined cost of those three plans is less than the District Contribution CAP ( example: $1655 for full time certified staff) the district will deposit the difference (savings) into your Health Savings Account automatically for employees who already have an HSA set up, otherwise you will need to set up that account through American fidelity, Optum or a bank of your choice!!!
For example, you could choose a plan combination (medical, dental and vision) totaling $1,554.71 per month. That means the district would deposit: ($1,655- $1,554.71) = $100.29 each month into your HSA account. That's $1,203.48 this year into your HSA account that may be saved or used for qualifying expenses. If you are generally healthy and have very few medical expenses, that money will continue to accrue year after year. It is not a 'use it or lose it' plan like the Flexible Medical Spending Account (Section 125. ) Most financial institutions offer debit cards to access your H.S.A. and you do NOT need to submit receipts to the bank. However you are accountable to the IRS, so you may want to keep receipts at home in case you are audited in the future.
CURRENT SECTION 125 PARTICIPANTS:
If you are contributing into a section 125 plan now, and choose to open a Health Savings Account, you need to know the IRS again has rules regulating your tax liability. The IRS will NOT allow you to have money in a Section 125 while also contributing to a Health Savings Account. This is very important because on the last day of your Section 125 plan year (October 31, 2025) you must not have any money remaining in your Section 125 Flex plan. The district will "hold in trust" your HSA contributions during the run out period for your Section 125 (January 2025 if your Flex dollars were used up in time, or 90 days into the new year if you had even $0.01 in your Flex). Please talk to Todd Wells (Todd.Wells@americanfidelity.com) at American Fidelity if you have any questions at all about coordinating a smooth transition from Flex to HSA.
2025 ANNUAL H.S.A. CONTRIBUTION MAXIMUM:
*includes both employee and employer contributions
$4,300 If the account owner (employee) has individual coverage on Moda Plans 6 or 7
$8,550 If the account owner (employee) has more than just the employee covered on Moda Plans 6 or 7.
$1,000 additional "Catch-up" contribution for participants who are age 55 or older.
2026 ANNUAL H.S.A.CONTRIBUTION MAXIMUM:
*includes both employee and employer contributions
$4,400 If the account owner (employee) has individual coverage on Moda Plans 6 or 7
$8,750 If the account owner (employee) has more than just the employee covered on Moda Plans 6 or 7.
$1,000 additional "Catch-up" contribution for participants who are age 55 or older.
HSA Resources:
View OEBB's Video explaining HSAs
View American Fidelity's HSA video
HSA Frequently Asked Questions
View IRS Publication 969 Regarding Health Savings Accounts
Department of The Treasury Resource Center
HSA ENROLLMENT FORMS
***HSA ENROLLMENT FORMS ARE DUE IN THE PAYROLL DEPARTMENT BY YOUR ENROLLMENT DEADLINE***
FAX or email: 541-447-3645 or email to: tera.rozewski@crookcountyschools.org
AMERICAN FIDELITY
(Send application to Tera Rozewski in payroll, do NOT submit online)
Complete the American Fidelity H.S.A. enrollment form below to open an American Fidelity Health Savings Account.
American Fidelity ENROLLMENT APPLICATION
DO NOT ENROLL ONLINE! SUBMIT PAPER APPLICATION TO PAYROLL!
For HSA support call: 866-326-3600 or e-mail customer service directly at HSA Support.
Todd Wells
Account Manager
American Fidelity Assurance Company
1-877-293-1090 ext 13
Fax: 1-877-295-1091
todd.wells@americanfidelity.com
SELF-SERVICE TUTORIALS:
OPTUM BANK
Complete the Optum H.S.A. application below to open an Optum Bank Health Savings Account. Once you have the the form completed please send it to payroll.
Optum Bank 2025-26 HSA Enrollment Form
DO NOT ENROLL ONLINE! SUBMIT PAPER APPLICATION TO PAYROLL!
Contact Optum directly to gain access to your account after it is established: 888-445-8745.
ANY OTHER BANK
If you elect to establish a Health Savings Account with your own bank, you must first visit the bank and open an account. Then complete and send your Payroll Department the:
HSA Enrollment form 2025-26 Any bank other than US Bank or American Fidelity
Click on "BLUE" text to link to the page or website listed.
For a speedy response, send your email questions to Benefits Mail Box.
Click here to go directly to the Forms Library and to find Links to Company Resources