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HSA Bank - Account Holders
 

HSA Withdrawal Options

Debit Card

Debit Card The debit card from Visa® allows you to pay for eligible medical expenses. The card is restricted to locations where medical goods and services are provided, such as pharmacies and doctor offices.

Tips on Using Your Debit Card

Checks

Checks Check writing capabilities offer customers immediate access to their Health Savings Account, so you don't have to wait to get reimbursed by a TPA or an insurance company. The checks should only be used for medical purchases or medical services. A listing of qualified medical expenses can be found in IRS Publication 502. Check purchases are limited only by your available account balance. Withdrawals from your account for non-medical reasons must be made by sending HSA Bank a completed Withdrawal Form for a fee of $10.00. The bank will then issue you a check.

Withdrawal/Contribution Form

The Withdrawal Form allows you to reimburse yourself for expenses already incurred or withdraw money for non-qualified expenses. Please allow up to 2 weeks to receive your disbursement. You need to complete the Withdrawal Form and mail or fax it back to HSA Bank.

Withdrawal Option

Issuance Fee

Per Transaction

Restrictions

Debit Card

Up to 2 cards at account opening (FREE)

4 year renewal ($6 per card)

Signature (FREE)

PIN ($2.00 / Trans)

Medical Purposes ONLY (normal distribution)

Checks

$7.95 for 50 duplicate checks

FREE

Medical Purpose ONLY (normal distribution)

Withdrawal Form

Not Applicable

$10 per occurrence

None