Further Health Savings Account Custodial Agreement
The Account Holder and the Custodian make the following agreements. "You" and "your" mean the Account Holder and "us", "we", and "our" mean the Custodian, MII Life Inc. d.b.a. Further. "HDHP" means the high deductible health plan used in conjunction with this health savings account, and "IRC" means the Internal Revenue Code as currently enacted or later amended.
- We will accept your cash contributions for the tax year made by you or on your behalf (by an employer, family member or any other person). Except for rollover contributions, we will not accept contributions in excess of the maximum amount for an account owner with family coverage plus the catch-up contribution (if applicable).
- Contributions for any tax year may be made at any time before the deadline for filing your federal income tax return for that year (without extensions).
- Rollover contributions from another HSA or an Archer Medical Savings Account (Archer MSA) (if permitted under this agreement) are not subject to the maximum annual contribution limit set forth in Article II.
- Rollover contributions from an IRA may be permitted on a one time (tax free) basis and are subject to the maximum annual contribution limit set forth in Article II.
- The Agreement becomes effective and your HSA is established as of the date we approve your completed HSA Application. We will provide you with confirmation of approval. For tax purposes, your HSA may not be effective until funds are deposited in your HSA.
- We assume no responsibility for tax or other consequences to anyone arising from the establishment or use of the HSA. You are solely responsible for any taxes, interest, penalties and other expenses which may be payable under applicable law in connection with your HSA. Because of the unfavorable tax consequences that could result from improper or mistaken establishment or use of any HSA, you may wish to consult with an attorney or other qualified tax professional before executing the HSA Application.
- The funds in your HSA may not be used to satisfy the debts, contracts or torts of any person entitled to distributions under this Agreement. You may not assign or transfer your right in your HSA except as otherwise provided in this Agreement.
- The total amount that may be contributed to your Health Savings Account (HSA) for any taxable year is limited based upon statutory limitations (as adjusted by IRS cost of living adjustments) for the type of high deductible health plan (HDHP) coverage that you have. In general, you will be entitled to contribute 1/12 of the annual statutory limitation for each month in which you are an eligible individual. Also, if you are an eligible individual on December 1st, you may be able to make the full annual contribution for the year (based upon your coverage category) even though you were not an eligible individual for the entire year as long as you maintain eligibility through December of the following year. Failure to remain an eligible individual until December 31st of the following year may result in an excise tax payable by you. The maximum annual contribution limits can be found on our website www.hellofurther.com or by contacting our customer service team at 1-800-859-2144, 7 a.m. to 8 p.m. Central Time, Monday through Friday.
- Contributions to Archer MSAs or other HSAs count toward the maximum annual contribution limit to this HSA.
- An additional $1000 catch-up contribution may be made for an Account Owner who is at least age 55 and less than age 65.
- Contributions in excess of the maximum annual contribution limit are subject to an excise tax. However, the catch-up contributions are not subject to an excise tax.
It is your responsibility to determine whether contributions to this HSA have exceeded the maximum annual contribution limit described in Article II. If contributions to this HSA exceed the maximum annual contribution limit, you must notify us that there are excess contributions to the HSA. It is your responsibility to request the withdrawal of the excess contribution and any net income attributable to such excess contribution.
Your interest in the balance in this HSA is not forfeitable.
- No part of the custodial funds in this account may be invested in life insurance contracts or in collectibles as defined in IRC section 408(m).
- The assets of this account may not be commingled with other property except in a common trust fund or common investment fund.
- Neither you nor we will engage in any prohibited transaction with respect to this account (such as borrowing or pledging the account or engaging in any other prohibited transaction as defined in IRC section 4975).
- Distribution of funds from this HSA may be made at any time upon your direction.
- Distributions from this HSA that are used exclusively to pay or reimburse qualified medical expenses of you, your spouse, or your tax dependents are tax-free. However, distributions that are not used for qualified medical expenses of such individuals are included in your gross income and are subject to an additional 20 percent excise tax on that amount. The additional 20 percent tax does not apply if the distribution is made after you die, become disabled, or reach age 65.
- We are not required to determine whether the distribution is for the payment or reimbursement of qualified medical expenses. Only you are responsible for substantiating that the distribution is for qualified medical expenses and must report any such distributions on your annual tax return (Form 8889) and maintain records sufficient to show that the distribution is tax-free.
- All transfers or distributions must be made in accordance with the Code, other applicable law and this Agreement.
- If a request for a transfer is made pursuant to the terms of a divorce or separation agreement, we must receive the request within 90 days of the effective date of the divorce or separation instrument. Transferring your interest to someone other than your spouse may subject you to income tax and penalties on the transferred amount.
- You will have the right at any time to designate primary and contingent beneficiaries to whom your HSA funds will be distributed upon your death. To be valid, any such beneficiary designation must be delivered to us prior to your death on a form provided by us. Any such beneficiary designation may be revoked by you at any time by delivering written notice of the revocation to us, and shall be automatically revoked upon receipt by us of a subsequent beneficiary designation in valid form bearing a later execution date. You understand that the consent of your spouse may be necessary if you wish to name a person other than or in addition to your spouse as beneficiary or to change an existing beneficiary designation. If there is no beneficiary designation on file with us at the time of your death, your legal spouse will be deemed to be your beneficiary. If you are not married at the time of your death, the funds will be paid to your estate.
- You represent and warrant that any beneficiary designation submitted to us satisfies all legal requirements under applicable law. We may presume that a beneficiary is legally competent until we receive written notice to the contrary. Whenever any distribution hereunder is payable to a person known by us to be a minor or otherwise under a legal disability, we, in our sole discretion, may authorize all or any part of such distribution to:
- a legal guardian or conservator for such person;
- a custodian under the Uniform Transfers to Minors Act, including any person or entity designated as such by us if such designation is permitted by applicable law;
- a parent of such person; or
- such person directly.
- If you designate your legal spouse as your beneficiary, your spouse will be treated as the new Account Holder of your HSA upon your death. Your spouse can then avoid paying tax by complying with the rules regarding qualified medical expenses.
- If you do not designate your surviving legal spouse as your beneficiary, or your HSA passes to someone else, it ceases to be an HSA as of the date of your death, and the beneficiary may be subject to income tax on the fair market value of your HSA, reduced by any payments made for your qualified medical expenses, if paid within one year of your death.
- You agree to provide us with information necessary for us to prepare any report or return required by the Internal Revenue Service.
- We agree to prepare and submit any report or return as prescribed by the Internal Revenue Service.
Notwithstanding any other article that may be added or incorporated in this Agreement, the provisions of Articles I through VIII and this sentence are controlling. Any additional article in this agreement that is inconsistent with IRC section 223 or IRS published guidance will be void to the extent of any inconsistency.
The rights, duties, and obligations of both you and us with regard to your HSA are governed exclusively by this Agreement. We may amend this Agreement without your consent and any amendment will become effective on the date stated in the notice regarding such amendment; provided that this Agreement will be amended automatically to comply with any change in the IRC, or other laws, as of the effective date of such change. If any provision of this Agreement is found to be in conflict with the IRC or other laws, the IRC or such other laws will supersede that provision.
- Fees. We assume and agree only to provide custodial and administrative services under section 223(a) and applicable regulations. You agree to pay the fees we charge for providing custodial and related administrative services in connection with your HSA. We may change the fees we charge by giving you at least 30 days written notice before the fees change. If the IRS permits, and we agree, you may pay these fees directly upon receipt of our bill. Otherwise, we will deduct these fees from your HSA. You agree to pay fees for all services we provide through the date your HSA ends. If you pay our fees in advance, we will prorate the fees to the termination date and refund to you, or credit your HSA, the unearned fees. You agree that we may keep, as additional compensation for the custodial and related administrative services we provide, any credit, interest or other earnings we receive on your HSA account balances in excess of the amount of interest that we may credit to your HSA from time to time. We may share fees and/or fee revenue with our contractors, including contractors that are our affiliates. Any fees paid by you or your HSA will be disclosed to you and your continued use of our services or the services of our contractors will be considered approval of such fees. In addition, we or our contractors may receive interchange fees from parties other than us for use of HSA debit cards. The interchange fees may vary, but in all cases will be equal to or less than the highest possible fee allowed for all card transactions. Neither you nor we are responsible for the payment of any interchange fee and such fees may not be deducted from your HSA.
- HSA Account Balance. Further is an IRS approved non-bank HSA trustee. Our approval letter from the United States Treasury is available at www.hellofurther.com or by contacting our customer service team at 1-800-859-2144, 7 a.m. to 8 p.m. Central Time, Monday through Friday. Contributions will generally be available for withdrawal from your account within two to five business days of our receipt. Deposits made outside of our normal business hours will be considered to be made on our next business day. In the event your account has a zero balance and also has outstanding fees you understand We, in our sole discretion, may convert your account to the FreeSaver product to avoid generating additional fees to your account or close your account. The SelectSaver HSA is FDIC insured. All other HSA products are not FDIC insured.
- SelectSaver. All contributions you deliver to us in your Base Balance are maintained in an aggregate account established for the benefit of all of our HSA Account Holders at a Federal Deposit Insurance Corporation (FDIC) insured financial institution of our choosing. The interest rate for the month will be disclosed to you in your on-line account transaction history and (where applicable) in periodic account statements. We reserve the right in our sole discretion to change the rate of interest we credit on HSA account balances we hold at any time and to establish and apply different rates of interest depending on the amount of balance. We may receive compensation in connection with aggregate cash account balances we deposit. You are entitled to interest on your cash account as specified herein, but otherwise not to any portion of the compensation we may receive in connection with the accounts in excess of calculated interest amounts we pay you. Such compensation retained by us will not exceed the U.S. Prime Rate (as published in the Wall Street Journal).
- PremiumSaver, BasicSaver, ThriftSaver, FreeSaver. We hold all HSA cash contributions you deliver to us in your Base balance as a deposit fund item in our general account. We guarantee the payment of HSA account balances we hold. We guarantee all interest we credit to your HSA account balance. You are not exposed to any investment risk on HSA account balances we hold. You have no right to share in any investment income, gains or losses we may experience in our general account assets. As a life insurance company regulated under Minnesota law, our general account is subject to review at all times by the Minnesota Department of Commerce. The guarantees we provide are based on our continued claims paying ability. We are not a bank. HSA account balances we hold are not bank deposits and are not insured or guaranteed by the Federal Deposit Insurance Corporation or any government agency. We reserve the right in our sole discretion to change the rate of interest we credit on HSA account balances we hold at any time and to establish and apply different rates of interest depending on the amount of balance. Investment of HSA Account Balance. You authorize us to enter into one or more arrangements with unaffiliated trust companies, broker-dealers, investment advisers and record-keepers (collectively, "Investment Providers") to give you access to a variety of self-directed and self- managed investments for your HSA. As long as your HSA account balance exceeds any threshold we may establish from time to time, you may choose to use any of these available investment options by agreeing to additional terms and conditions relating to the use of the investment options, including but not limited to approving the additional fees and compensation the Investment Providers may charge or receive in connection with your use of these arrangements. You agree that you have the sole and exclusive right to direct the investment of your HSA account balance in excess of any threshold we may establish from time to time in the available investment options. You agree that we have no investment discretion to act on your behalf. We will not provide you with any investment advice. If you invest, we are not responsible or liable for any investment decision you make or any investment loss you may suffer. We are not responsible to question any investment decision you make. We are not responsible for any loss that results when we do not act because you did not direct us to take an action. If we receive an investment instruction from you that we do not understand, we will make reasonable efforts to contact you promptly in order to clarify your instruction, however, pending clarification, we will hold your contribution uninvested without liability for loss of income or appreciation and without liability for interest or dividends or for market losses.
- Distributions. You can direct a distribution of funds from your HSA at any time using any of the methods that we then make available. We always fund a distribution request from amounts you have not invested, i.e., amounts which we hold as part of our general account assets. If the amount of your distribution request is greater, and you have contributions invested through the Investment Providers, you must liquidate enough of your investments to complete the funding of the distribution. We have the right to liquidate assets in your HSA investment account if necessary to make distributions or to pay fees, expenses, taxes, penalties or surrender charges properly chargeable against your HSA. If you fail to direct us as to which assets to liquidate, we will decide, in our complete and sole discretion, and you agree not to hold us liable for any adverse consequences that result from our decision. The amount liquidated will be the higher of the investment threshold amount or your investment balance. Distributions by check in an amount we determine to be nominal may require your specific direction to be paid. This can be done by contacting our customer service team at 1-800-859-2144, 7 a.m. to 8 p.m. Central Time, Monday through Friday.
- Hold Harmless. You agree to hold us harmless and to indemnify and defend us against any and all claims arising from and liabilities incurred by reason of any action we take in good faith under this agreement.
- Rollover Contributions. We generally accept transfers from another HSA of Archer MSA, however, we reserve the right to refuse to accept any transfer.
- Termination. You may transfer all or a portion of your HSA balance to another HSA custodian or trustee at any time by giving us written notice and instructions. We may terminate this Agreement at any time by giving written notice to you. We may resign as custodian, without your consent, upon written notice to you. Upon our resignation, we will either appoint a successor custodian (see next paragraph), ask you to appoint a successor custodian, or we will distribute the remaining assets in the HSA to you. We may also close an account that we determine to be inactive with a balance less than an amount we determine to be nominal without notice to you and may use the residual balance as an offset to any account closing fee. If the Agreement is terminated, we will cancel any outstanding debit associated with your account at the time of termination. If we distribute the assets, you are responsible for the tax consequences of the distribution. We shall not be liable for any actions or failures to act on the part of any successor custodian or trustee, nor for any tax consequences you may incur that result from the transfer or distribution of your assets pursuant to this section. If this Agreement is terminated, we may charge to your HSA a reasonable amount of money that we believe is necessary to cover any associated costs, including but not limited to, one or more of the following;
- Any fees, expenses or taxes chargeable against your HSA;
- Any penalties or surrender charges associated with the early withdrawal of any savings instrument or other investment in your HSA.
Appointment of Successor Custodian: Pursuant to this Article XVIII, we may resign as custodian and appoint a successor custodian that we choose. The successor custodian (or trustee) must be a bank (as defined in Code Section 408(n)), an insurance company (as defined in section 816), or another person who satisfies the IRS requirements for HSA custodial duties. The appointment of a successor custodian will become effective immediately; provided, however, that you will retain your right to terminate this Agreement pursuant to this Article XVIII. If you do not exercise your right to terminate this agreement and request a complete distribution or designate a new custodian or trustee, you will be deemed to have automatically accepted the successor custodian. In the event that a successor custodian is appointed, the successor custodian’s HSA Custodial Agreement and all related account documentation will automatically become applicable. In such case, you will receive a copy of the new custodial agreement and related documentation.
- Amendments and Governing Law. We may amend this HSA Custodial Agreement at any time. We will provide you with a copy of any amendment at least 30 days before the amendment becomes effective. This agreement shall be construed and interpreted in accordance with the laws of the state of Minnesota, except to the extent federal law applies.
- Responsibility. You are responsible to provide us with complete and accurate information including updates to your account profile. Unless you instruct us otherwise, we may update your postal or e-mail address of record if we receive a change notice from the US Postal Service or we receive change information from an address change service. We are responsible to not accept any contributions, other than rollover contributions, that exceed the maximum family annual contribution limit. We are not responsible for any taxes or losses that you incur in connection with your HSA.
- Successors and Assigns. If we change our name, reorganize, merge with another organization (or come under the control of any Federal or state agency), or if our entire organization (or any portion which includes your HSA) is bought by another organization, that organization (or agency) shall automatically become the trustee or custodian of your HSA, but only if it is qualified under the Code to serve as an HSA custodian or trustee. If the new organization is not qualified to be an HSA custodian or trustee as required by Code Section 223, the HSA will be terminated effective as of the date the new organization takes control and all funds in your HSA will be distributed in accordance with the termination provision set forth herein. In addition, notwithstanding anything herein to the contrary, we reserve the right to assign your HSA without your prior consent, provided that such assignee is qualified under the Code to be an HSA custodian or trustee. We will notify you if we assign your HSA to another custodian or trustee. We may, without your authorization, engage the services of a third party to assist us with the services provided under this Agreement.
- Unclaimed property Law. Unclaimed property laws require us to turn over abandoned accounts to the applicable state, which is generally the state listed in the address for your HSA account statement. Your HSA is usually considered abandoned if you have not performed at least one of the following activities for the period of time specified in the applicable state’s unclaimed property law: made a deposit or withdrawal, written to us about the account, or otherwise shown an interest in the account, such as asking us to keep the account active. Please note that you need to perform the activity, so automatic deposits and withdrawals may not be considered under your state’s unclaimed property laws. Before we turn over an abandoned account, we may send a notice to the email address or physical address we currently show for your account. If mail we previously sent to either address was returned, we may not send this notice. If you have not made a deposit to or withdrawal from your account for a period of time that we consider substantial, then (unless prohibited by law) we may charge dormant account fees on the account in addition to regular monthly maintenance and other fees and we may stop paying interest on the account. If you re-establish contact with us, we do not have to reimburse you for these fees, and we are not liable to you for any interest that would otherwise have accrued on your account. We may also refuse to pay attempted withdrawals from the account unless we can establish that they are being made at the direction of you or another authorized signer.
- Debit Card. If you elect to receive and use a debit card in conjunction with this account, you agree to review and accept the debit card terms and conditions statement that will be supplied with the debit card.
- Data Privacy. Keeping your account information confidential and secure is a priority for Further. You agree to review and accept the Further Policy information that will be supplied to you initially at enrollment and updated periodically thereafter. It can also be found on our website www.hellofurther.com or by contacting our customer service team at 1-800-859-2144, 7 a.m. to 8 p.m. Central Time, Monday through Friday. In general, your data is not shared with others unless there is a legitimate business reason to do so. For example to properly administer your account we may need to share your account information with our business partners and associates.
HSA Custodian Information
MII Life Inc. d.b.a. Further
P.O. Box 64193, St Paul, Minnesota, 55164