AFA - Health Savings Accounts

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»	Setting Up An HSA

Complete these 5 steps to set up your Health Savings Account (HSA).
For your convenience detailed instructions are also available in a PDF file.
Note: If you are an employee, you may want to check your employers benefits offerings.

Step 1. Obtain an HSA qualified high deductible health plan (HDHP)**.

The following minimum must apply to all medical expenses:

Individual Coverage $1,100* (2008)
Family Coverage $2,200* (2008)

The sum of annual deductibles and out-of-pocket expenses cannot exceed:

Individual Coverage $5,600* (2008)
Family Coverage $11,200* (2008)

* Minimum deductibles and out-of-pocket expenses are indexed annually.
** Contact your health insurance provider to verify that your plan is a qualified HDHP.

Step 2. Download and complete an HSA Application Custodial/Agreement, guidelines are included on the application.

Step 3. If requesting a debit card for yourself and would like one for your dependent, download and complete the Request for Dependent Debit Card.

Step 4. Enclose two checks as described below:

One-time setup fee $15.00 Payable to AFHSA
Minimum opening deposit $50.00 Payable to InvesTrust, N.A.

Step 5. Mail the Application/Custodial Agreement, and Request for Dependent Debit Card (if applicable), and your checks to:

American Fidelity Assurance Health Services Administration
P.O. Box 25523, 2000 N. Classen Blvd.
Oklahoma City, OK 73125-0523

When we receive your application and payment we will:

Set-up your investment account.

Mail a welcome kit to you 3 - 5 business days after receipt of your application.

Mail a debit card, if requested, to you 7 - 10 business days after we receive your application.

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