Instructions For Form 8889 - Health Savings Accounts Hsas

5. If you were not an eligible

Step 2. Divide the refigured

Line 1

individual on the first day of the last

contribution limit from Step 1 equally

If you were covered, or considered

month of your tax year, use the Line 3

between you and your spouse, unless

covered, by a self-only HDHP and a

Limitation Chart and Worksheet on

you both agree on a different allocation

family HDHP at different times during

page 3 to determine the amount to

(such as allocating nothing to one

the year, check the box for the plan that

enter on line 3. (See (6) below.)

spouse).

was in effect for a longer period. If you

6. If, at the end of 2007, you were

Step 3. Subtract the part of the

were covered by both a self-only HDHP

age 55 or older and unmarried or

contribution limit allocated to your

and a family HDHP at the same time,

married with self-only HDHP coverage

spouse in Step 2 from the amount

you are treated as having family

for the entire year, you can increase the

determined in Step 1.

coverage during that period. If, on the

amount determined in (3) or (4) by

first day of the last month of your tax

Step 4. Determine any other

$800 (the additional contribution

year, December 1 for most taxpayers,

contribution limits that apply for the tax

amount). For (5), the additional

you had family coverage, check the

year and add that amount to the result

contribution amount is taken into

“family” box.

in Step 3. Enter the total on line 6.

account for each month you are an

eligible individual.

Example. In 2007, you are an

Line 2

eligible individual and have family

Note. If you are married and had

Include on line 2 only those amounts

HDHP coverage. In March you divorce

family coverage at any time during the

you, or others on your behalf,

and change your coverage as of April 1

year, the additional contribution amount

contributed to your HSA. Include those

to self-only. Neither you nor your

is figured on line 7 and is not included

contributions made from January 1,

spouse qualify for the additional

on line 3.

2008, through April 15, 2008, that were

contribution amount. Your spouse

for 2007. Do not include employer

continued to have family HDHP

See Pub. 969 for more information.

contributions (see line 9) or amounts

coverage and was an eligible individual

If you must complete the line 3

rolled over from another HSA or Archer

for the entire year. The contribution limit

TIP

MSA, or a qualified HSA distribution.

worksheet, and your eligibility

for the 3 months you both were

See Rollovers on page 2. Also, do not

and coverage did not change

considered to have family coverage is

$1,412.50 ($5,650 × 3 ÷ 12). You and

include any qualified HSA funding

from one month to the next, enter the

same number you entered for the

distributions (see line 10). Contributions

your spouse divide the family coverage

to an employee’s account through a

previous month.

contribution equally. Your contribution

cafeteria plan are treated as employer

limit for 9 months of self-only coverage

Line 6

is $2,137.50 ($2,850 × 9 ÷ 12). This

contributions and are not included on

line 2.

Spouses who have separate HSAs and

amount is not divided between you and

had family coverage under an HDHP at

your spouse.

Line 3

any time during 2007, use the following

Because you are covered under a

rules to figure the amount on line 6.

When figuring the amount to enter on

self-only policy on December 1, you will

•

If you are treated as having family

line 3, apply the following rules.

show $2,850 on line 6 (the greater of

coverage for each month, divide the

1. Use the family coverage amount

either (a) $2,843.75 ($1,412.50 family

amount on line 5 equally between you

if you or your spouse had an HDHP

coverage + $2,137.50 self-only

and your spouse, unless you both

coverage – $706.25 spousal allocation)

with family coverage. Disregard any

agree on a different allocation (such as

or (b) the maximum amount that can be

plan with self-only coverage.

allocating nothing to one spouse). Enter

2. If the last-month rule (see page

contributed ($2,850 for self-only

your allocable share on line 6.

1) applies, you are considered an

coverage)). Your ex-spouse would

Example. In 2007, you are an

show $5,650 on line 6 (the greater of

eligible individual for the entire year.

eligible individual and have self-only

either (a) $4,943.75 ($1,412.50 family

You are treated as having the same

HDHP coverage. In March you marry

HDHP coverage for the entire year as

coverage for the 3 months prior to the

and as of April 1 you have family HDHP

you had on the first day of the last

divorce + $4,237.50 family coverage

coverage. Neither you nor your spouse

maintained after the divorce – $706.25

month of your tax year.

qualify for the additional contribution

spousal allocation) or (b) the maximum

3. If you were, or were considered,

amount. Your spouse has a separate

an eligible individual for the entire year

amount that can be contributed ($5,650

HSA and is an eligible individual from

and you did not change your type of

for family coverage)).

April 1 to December 31, 2007. Because

coverage, enter $2,850 for a self-only

Line 7

you and your spouse are considered to

HDHP or $5,650 for a family HDHP on

have family coverage on December 1,

line 3. (See (6) below.)

Additional Contribution Amount

your contribution limit is $5,650 (the

4. If you were, or were considered,

family coverage maximum). You and

an eligible individual for the entire year

If, at the end of 2007, you were age 55

your spouse can divide this amount in

and you changed your type of coverage

or older and married, use the Additional

any allocation to which you agree (such

during the year, enter on line 3 (see (6)

Contribution Amount Worksheet on

as allocating nothing to one spouse).

below) the greater of:

page 5 if both of the following apply.

•

If you are not treated as having

a. The limitation shown on the last

1. You or your spouse had family

family coverage for each month, use

line of the Line 3 Limitation Chart and

coverage under an HDHP and were, or

the following steps to determine the

Worksheet on page 3, or

were considered to be, an eligible

amount to enter on line 6.

b. The maximum amount that can

individual on the first day of the month.

Step 1. Refigure the contribution

be contributed based on the type of

2. You were not enrolled in

limit that would have been entered on

HDHP coverage you had on the first

Medicare for the month.

line 5 if you had entered on line 3 the

day of the last month of your tax year.

total of the worksheet amounts only for

Enter the result on line 7.

If you had family coverage on

the months you were treated as having

If items (1) and (2) apply to all

TIP

the first day of the last month,

family coverage. When refiguring line 5,

TIP

months during 2007, enter $800

you do not need to use the

use the same amount you previously

on line 7.

worksheet; enter $5,650 on line 3.

entered on line 4.

-4-

Instructions For Form 8889 - Health Savings Accounts Hsas - 2007 Page 4

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