HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENTHealth Savings Account Custodial Agreement • January 31st, 2005
The account holder whose name appears on the attached Application ("Depositor") is establishing a Health Savings Account ("HSA") under Section 223(a) of the Internal Revenue Code ("Code") exclusively for the purpose of paying or reimbursing qualified medical expenses of the Depositor and his or her spouse and dependents. The Depositor has assigned to the custodial account the sum indicated on the Application. The Depositor represents that, unless this account is used solely to make rollover contributions, he or she is eligible to contribute to this HSA; specifically, that he or she: (1) is (or as of the effective date as set forth in the Application will be) covered under a high deductible health plan ("HDHP"); is not also covered by any other health plan that is not an HDHP (with certain exceptions for plans providing preventative care and limited types of permitted insurance and permitted coverage); (3) is not enrolled in Medicare; and (4) cannot be claimed as a dependent on another
HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENTHealth Savings Account Custodial Agreement • March 22nd, 2022 • Massachusetts
This Health Savings Account Custodial Agreement contains a Dispute resolution provision that includes an agreement to arbitrate Disputes. The Dispute resolution provision, which is in Section VIII of this Agreement, is called “Dispute Resolution and Binding Arbitration.” Please read this section carefully because it will have a substantial effect on your rights, including your right to bring or participate in a class action or to have a jury trial in the event of a Dispute between you and us. However, even if the section applies to you, you may reject arbitration of Disputes by following the steps noted in that section within 30 days of the Effective Date of this Agreement.
HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENTHealth Savings Account Custodial Agreement • July 6th, 2004
The depositor whose name appears on the attached Application is establishing a Health Savings Account under Section 223(a) of the Internal Revenue Code (“Code”) for the
HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENTHealth Savings Account Custodial Agreement • March 21st, 2005
The accountholder whose name appears on the attached Application ("Depositor") is establishing a Health Savings Account ("HSA") under Section 223(a) of the Internal Revenue Code ("Code") exclusively for the purpose of paying or reimbursing qualified medical expenses of the Depositor and his or her spouse and dependents. The Depositor has assigned to the custodial account the sum indicated on the Application. The Depositor represents that, unless this account is used solely to make rollover contributions, he or she is eligible to contribute to this HSA; specifically, that he or she: (1) is (or as of the effective date as set forth in the Application will be) covered under a high deductible health plan ("HDHP"); (2) is not also covered by any other health plan that is not an HDHP (with certain exceptions for plans providing preventative care and limited types of permitted insurance and permitted coverage); (3) is not enrolled in Medicare; and (4) cannot be claimed as a dependent on anoth
Health Savings Account Custodial AgreementHealth Savings Account Custodial Agreement • December 13th, 2023
This Health Savings Account Custodial Agreement (“Agreement”) sets forth the terms and conditions that govern your Health Savings Account (“Account” or “HSA”) with DataPath Financial Services. Throughout this Agreement, the words “Custodian,” “DFS,” “we,” “us,” or “our” means DataPath Financial Services, Inc., its successors and assigns and “you,” “your,” or “yours” means the named account owner of the HSA, any spouse beneficiary upon the death of the HSA owner, or any third- party authorized or appointed to access and use the HSA. The terms of this Agreement shall be binding upon you and the Custodian.
HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENTHealth Savings Account Custodial Agreement • November 5th, 2007
The account owner named on the application is establishing this health savings account (HSA) exclusively for the purpose of paying or reimbursing qualified medical expenses of the account owner, his or her spouse, and dependents. The account owner represents that, unless this account is used solely to make rollover contributions, he or she is eligible to contribute to this HSA; specifically, that he or she:
