Contribution/Deposit Form
Once you’ve contributed money to your health savings account (HSA), you can use it to pay for qualified medical expenses for yourself, your spouse and your eligible dependents. The amount you spend will be federal income tax-free.
Examples of qualified medical expenses
The following list includes common examples of HSA qualified medical expenses. For a complete list, visit irs.gov and search for Publication 502, Medical and Dental Expenses.
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