Instructions For Form 8889 - Health Savings Accounts - 2005


2 0
Department of the Treasury
Internal Revenue Service
Instructions for Form 8889
Health Savings Accounts (HSAs)
the qualified medical expenses of the
* This limit does not apply to deductibles and
General Instructions
expenses for out-of-network services if the plan
account beneficiary or the account
uses a network of providers. Instead, only
Section references are to the Internal
beneficiary’s spouse or dependents.
deductibles and out-of-pocket expenses (such as
Revenue Code unless otherwise
copayments and other amounts, but not
Distributions From an HSA
premiums) for services within the network should
be used to figure whether the limit is reached.
Distributions from an HSA used
Purpose of Form
exclusively to pay qualified medical
An HDHP can provide preventive
expenses of the account beneficiary,
Use Form 8889 to:
care and certain other benefits with
spouse, or dependents are
Report health savings account
no deductible or a deductible below
excludable from gross income. You
(HSA) contributions (including those
the minimum annual deductible. For
can receive distributions from an HSA
made on your behalf and employer
more details, see Pub. 969. An HDHP
even if you are not currently eligible
does not include a plan if
to have contributions made to the
Figure your HSA deduction, and
substantially all of the coverage is for
HSA. However, any part of a
Report distributions from HSAs.
accidents, disability, dental care,
distribution not used to pay qualified
vision care, or long-term care. An
Additional information. See Pub.
medical expenses is includible in
HDHP also cannot be insurance that
969, Health Savings Accounts and
gross income and is subject to an
Other Tax-Favored Health Plans, for
you are permitted to have in addition
additional 10% tax unless an
to an HDHP. See Other Health
more details on HSAs.
exception applies.
Coverage below.
Who Must File
Qualified Medical Expenses
Other Health Coverage
You must file Form 8889 if any of the
Generally, qualified medical
If you have an HSA, you (and your
following applies.
expenses for HSA purposes are
spouse, if you have family coverage)
You (or someone on your behalf,
unreimbursed medical expenses that
generally cannot have any health
including your employer) made
could otherwise be deducted on
coverage other than an HDHP. But
contributions for 2005 to your HSA.
Schedule A (Form 1040). See the
your spouse can have health
You received HSA distributions in
Instructions for Schedule A and Pub.
coverage other than an HDHP if you
502, Medical and Dental Expenses
are not covered by that plan. If you
You acquired an interest in an HSA
(Including the Health Coverage Tax
have a health flexible spending
because of the death of the account
Credit). However, you cannot treat
arrangement or health reimbursement
beneficiary. See Death of Account
insurance premiums as qualified
arrangement, see Pub. 969.
Beneficiary on page 2.
medical expenses unless the
premiums are for:
Exceptions. You can have additional
insurance that provides benefits only
Long-term care (LTC) insurance,
Health care continuation coverage
Liabilities under workers’
Eligible Individual
(such as coverage under COBRA),
compensation laws, tort liabilities, or
Health care coverage while
To be eligible to have contributions
liabilities arising from the ownership
receiving unemployment
made to your HSA, you must be
or use of property,
compensation under federal or state
covered under a high deductible
A specific disease or illness, or
law, or
health plan (HDHP) and have no
A fixed amount per day (or other
other health coverage except
Medicare and other health care
period) of hospitalization.
permitted coverage. If you are an
coverage if you were 65 or older
You can also have coverage
eligible individual, anyone can
(other than premiums for a Medicare
(either through insurance or
contribute to your HSA. However, you
supplemental policy, such as
otherwise) for accidents, disability,
cannot be enrolled in Medicare or be
dental care, vision care, or long-term
claimed as a dependent on another
High Deductible Health Plan
person’s tax return. You must be an
eligible individual on the first day of a
An HDHP is a health plan that meets
For information on prescription
month to take an HSA deduction for
the following requirements.
drug plans, see Pub. 969.
that month.
Account Beneficiary
coverage coverage
An individual generally is considered
The account beneficiary is the
disabled if he or she is unable to
individual on whose behalf the HSA
Minimum annual
engage in any substantial gainful
was established.
activity due to a physical or mental
impairment which can be expected to
Maximum annual
Generally, an HSA is a health savings
result in death or to continue
account set up exclusively for paying
$5,100 $10,200
Cat. No. 37971Y


00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Page of 5