2013 HSA Contribution Limits Released

Summary of Benefit Coverage Requirements for Health FSAs and HRAs

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Mandatory field Name of Plan Sponsor (Company)*
Mandatory field Address*
Mandatory field City*
Mandatory field State*
Mandatory field Zip*
Mandatory field Principal*
Mandatory field Title*
Mandatory field Phone*
Fax
Mandatory field Email*
Mandatory field Employer Fed Tax ID Number*
Mandatory field Form of Organization*
Mandatory field Date of Incorporation*
Mandatory field Under Laws of (State)*
Mandatory field Principal Business Activities*
Mandatory field Effective Date of Plan*
Mandatory field Effective Date of Original Plan if this is an Amendment or Restatement of a Previously Established Plan*
Mandatory field Plan Name*
Mandatory field 3 Digit Plan Number*
Mandatory field Start Date for this Plan Year*
Mandatory field End Date*
Mandatory field Tax Year*
Mandatory field End Date*
Mandatory field Who will be the Administrator of this Plan*
Mandatory field Title*
Mandatory field Phone*
Fax
Mandatory field Email*
Mandatory field Number of Eligible Employees*
Mandatory field Eligibility Waiting Period*
Mandatory field Minimum Hours Per Week*
Mandatory field Minimum Age*

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