Do you want to enroll in a Health Savings Account (HSA)?

Please complete the HSA Enrollment Form. 

Additional information regarding the Health Savings Account benefit include:

• Enrollment in the HSA plan does automatically continue from one year to the next, so you do not need to fill out a new form unless you want to change your election. In addition, contribution amounts for the HSA can be updated and changed throughout the year as long as the employee is already enrolled.
• Employees who wish to participate in the HSA for the FY25 plan year and are not already enrolled (July 1, 2024 - June 30, 2025) MUST enroll during this open enrollment period.
• Benefit-eligible employees are eligible to participate in HSA plans only if they are enrolled in the State High Deductible health plan. You can change your plan to the High Deductible plan during open enrollment.