Add deposits

John Smith

52525252

004

11112

HCSA Deposits

HCSA - 0012345
(Start date of your policy year)
Initial
Add

TSA - 0012345
(Start date of your policy year)
Initial
Add

 

Start date of your policy year

For example, if the HCSA/TSA year is Jan 1 2016 to Dec 31 2016 (calendar year setup) always use Jan 1 2016 as the effective date of deposit for the initial deposit and subsequent additions if applicable. The following deposit year would start Jan 1 2017 and all deposits for the 2017 year would have a Jan 1 2017 effective date. If the HCSA/TSA has a policy year setup with a starting month other than January, that month/year start date is required. For example, if the HCSA year is from July 1 2016 to June 30 2017 always use July 1 2016 as the effective date of deposit. The following HCSA year starts July 1 2017 and new initial deposits and additions would have a July 1 2017 effective date. Do not use the Plan Member benefit effective date or hire date as the effective date of deposit. Please ensure an initial deposit is only loaded once per member per HCSA/TSA year. Deposit additions to an existing Plan Member who has had an initial deposit within the year in question should be submitted as an addition with an effective date at the start of the applicable HCSA/TSA year.