- 2020 School Employee Authorization for
Payroll Deduction to Health Savings Account
Use this form to have your SEBB organization withhold money from your paychecks and deposit it
into your health savings account (HSA) on a pretax basis.
- A Maximum amount you can put in your HSA for 2020: $3,550
B Are you age 55 or older? 4 Family maximum HSA contribution
Calculate your maximum HSA contribution
Use the worksheet below to determine how much you can contribute to your family HSA in 2020.
- If you are
submitting a mid-year change to increase your contribution amount, be sure to include any
amounts you have already contributed in 2020.
- If you need an accommodation...
HSA Payroll Deduction Form 
