Health Savings Account

A Health Savings Account (HSA) is a tax-exempt trust or custodial account established exclusively for the purpose of paying or reimbursing qualified medical expenses of you, your spouse and your dependents. To learn more, click here.

Account Features

• No Fees are associated with this account
• Have a minimum opening balance of $100
• If the account is not in overdraft, there are no service charges associated with this account. There is a $5.00 fee for every day that the account is in overdraft.
• Free Internet Banking and Delta Trust HSA Debit Cards are also available.
• 150 Non-duplicate checks are available for $19.42
• Paper statements are available at a $2.00 monthly fee. You can register for online banking and sign up for our e-statement services to receive an electronic statement at no charge.
• HSA account holders are offered an exclusive savings- account, Delta Trust Net Savings Account

Eligibility Requirements

You are eligible for a regular HSA contribution if, with respect to any month, you:

• Are covered under a high-deductible health plan (HDHP)
• Are not also covered by any other health plan that is not an HDHP*
• Are not enrolled in Medicare
• Cannot be claimed as a dependent on another person’s tax return

Effective January 1, 2011 over the counter medicine cannot be reimbursed. Penalty for non-medical distributions as of January 1st, 2011 will be 20%. (That is also the penalty for early withdrawal).

*With certain exceptions for plans providing preventative care and limited types of permitted insurance and permitted coverage.

BALANCE	INTEREST RATE	ANNUAL PERCENTAGE YIELD
Less than $3,000	0.31%	0.31%
$3,001 -$9,999	0.56%	0.56%
$10,000+	1.01%	1.01%

Interest rates subject to change. Any and all applicable fees may reduce earnings.  Interest Rates and Annual Percentage Yields effective 11/30/2012.

Contribution Amounts

2012 CONTRIBUTION AMOUNTS:
Self – $3,100.00
Family – $6,250.00

Note: Prior year contributions must be made by 4/15/2013

2013 CONTRIBUTION AMOUNTS:
Self – $3,250
Family – $6,450
THE CATCH-UP CONTRIBUTION (55 OR OLDER)* FOR 2012 – 2013
Self – $1,000
Family – $1,000
*If a spouse is also 55 or older, a second HSA must be established and a second contribution of $1,000 could be made to that account.

HSA Forms

Health Savings Account Application & Eligibility Form

(Application cannot be processed until a state issued driver’s license or ID card is submitted via fax or email. If you are designating a signer on the account then you must include the signer’s state issued driver’s license or ID card.)

HSA Transfer Request

HSA Employer Contribution Form

Please submit all HSA forms and direct any questions to the contact information below:

HSA Contact:

Delta Trust & Bank
ATTN: HSA Representative
PO Box 241084
Little Rock, AR 72223

Phone: 800.714.0165 or 501.907.0331
Fax: 501.975.4009
hsa@delta-trust.com