• Annual contributions are deductible from federal taxes up to the maximum allowable amount.
• Dividends earned are free from federal taxes.
• Qualified withdrawals are free from federal income tax.
• Some states allow tax deductibility and do not tax dividends earned. Consult your tax advisor for details.

No Monthly Charges for the First Year
The $1 monthly charge is waived for the first year.

Flexibility, Easy Access
Use funds to pay for qualified medical expenses when they occur. Plus, you can easily access the funds in your account with an HSA debit card, HSA checks, or through your local branch.

Other Benefits
The Patelco Rx Savings Program is available to all cost-conscious consumers to help you save money on brand-name or generic prescription medications. It is FREE to enroll. To learn more about this program, visit www.hpprx.com/patelco or call 727-526-0317.

MyMedLab.com specializes in proactive health care. They provide consumers with quality, convenient, low-cost lab testing with no membership fees to pay or groups to join. Visit their website at www.mymedlab.com or call 888-MY-MedLab.

Open An Account

Please note that there is a different process for opening an HSA depending on whether you currently have a Patelco account or not.

Non-Patelco Members
If you are not currently a Patelco member you must complete the following forms to join and open an HSA:

• HSA Membership Application and Eligibility Form (required)
• HSA Designation of Beneficiary (required)

And you may also need to complete these forms, depending on your situation:

• HSA Rollover Certification (optional)
• HSA Transfer Request (optional)
• HSA Withdrawal Statement (optional)
• HSA Contribution/Investment Form (optional)

Current Patelco Members
If you are currently a Patelco member you must complete the following forms to join and open an HSA:

• HSA Eligibility and Information (required)
• Health Savings Account Application (required)

And you may also need to complete these forms, depending on your situation:

• HSA Rollover Certification (optional)
• HSA Transfer Request (optional)
• HSA Withdrawal Statement (optional)
• HSA Designation of Beneficiary (optional)
• HSA Contribution/Investment Form (optional)
  
  

Employers
HR professionals need to complete this form to make the HSA available to your employees:

• HSA Employer Contribution Form (required)

Submit completed forms at any branch or mail to:

Patelco Credit Union
c/o Operational Support
156 Second Street
San Francisco, CA 94105

You can also open an account by visiting a local branch.
For more information call 415.442.6200 or 800.358.8228 (outside CA).

* The information on this page is provided by BISYS Retirement Services and the IRS, and is not intended as tax advice. Please consult a tax professional.
† Annual Percentage Yield. Rate is 5.00%.