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Instructions pour les formulaires 1099-SA et 5498-SA

Instructions pour les formulaires 1099-SA et 5498-SA, distributions provenant d'un HSA, Archer MSA ou Medicare Advantage MSA, et HSA, Archer MSA ou Medicare Advantage MSA Informations

Rév. 2023

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Department of the Treasury  
Internal Revenue Service  
2023  
Instructions for Forms  
1099-SA and 5498-SA  
Distributions From an HSA, Archer MSA, or Medicare Advantage MSA, and HSA,  
Archer MSA, or Medicare Advantage MSA Information  
Section references are to the Internal Revenue Code  
unless otherwise noted.  
Advantage MSA (MA MSA). The distribution may have  
been paid directly to a medical service provider or to the  
account holder. A separate return must be filed for each  
plan type.  
Future Developments  
For the latest information about developments related to  
Forms 1099-SA and 5498-SA and their instructions, such  
as legislation enacted after they were published, go to  
Transfers  
Do not report a trustee-to-trustee transfer from one Archer  
MSA or MA MSA to another Archer MSA or MA MSA,  
from an Archer MSA to an HSA, or from one HSA to  
another HSA. For reporting purposes, contributions and  
rollovers do not include transfers.  
Reminders  
In addition to these specific instructions, you should also  
use the 2023 General Instructions for Certain Information  
Returns. Those general instructions include information  
about the following topics.  
HSA Mistaken Distributions  
If amounts were distributed during the year from an HSA  
because of a mistake of fact due to reasonable cause, the  
account beneficiary may repay the mistaken distribution  
no later than the due date of the tax return (not counting  
extensions) following the first year the account beneficiary  
knew or should have known the distribution was a  
mistake. For example, the account beneficiary  
Who must file.  
When and where to file.  
Electronic reporting.  
Corrected and void returns.  
Statements to recipients.  
Taxpayer identification numbers (TINs).  
Backup withholding.  
reasonably, but mistakenly, believed that an expense was  
a qualified medical expense and was reimbursed for that  
expense from the HSA. The account beneficiary then  
repays the mistaken distribution to the HSA.  
Penalties.  
Other general topics.  
You can get the general instructions from IRS.gov/  
Under these circumstances, the mistaken distribution is  
not included in gross income, is not subject to the  
additional 20% tax, and the repayment is not subject to  
the excise tax on excess contributions. Do not treat the  
repayment as a contribution on Form 5498-SA, HSA,  
Archer MSA, or Medicare Advantage MSA Information.  
Continuous-use form and instructions. Form 1099-SA  
and its instructions are continuous use. Both the form and  
instructions will be updated as needed. For the most  
recent version, go to IRS.gov/Form1099SA.  
As the trustee or custodian, you do not have to  
Online fillable forms. Due to the very low volume of  
paper Forms 1099-SA and 5498-SA received and  
processed by the IRS each year, these forms have been  
converted to an online fillable format. You may fill out the  
forms, found online at IRS.gov/Form1099SA and IRS.gov/  
Form5498SA, and send Copy B to the recipient. For filing  
with the IRS, follow the applicable procedures if you are  
required to file electronically. For Forms 1099-SA and  
5498-SA only, if due to a low volume of recipients, you  
are filing the form(s) on paper, you can send in the  
black-and-white Copy(ies) A with a Form 1096 that you  
also printed from the IRS website.  
allow beneficiaries to return a mistaken  
TIP  
distribution to the HSA. However, if you do allow  
the return of the mistaken distribution, you may rely on the  
account beneficiary's statement that the distribution was  
in fact a mistake. See Notice 2004-50, 2004-33 I.R.B.  
196, Q/A-76, available at IRS.gov/irb/  
2004-33_IRB#NOT-2004-50. Do not report the mistaken  
distribution on Form 1099-SA. Correct any filed Form  
1099-SA with the IRS and the account beneficiary as soon  
as you become aware of the error. See Corrected Returns  
on Paper Forms in the current General Instructions for  
Certain Information Returns for more information.  
Specific Instructions for Form  
1099-SA  
HSA Closure Under the USA PATRIOT Act  
If an HSA is closed at any time by the HSA trustee or  
custodian due to a failure of the participant to satisfy the  
Customer Identification Program requirements described  
in section 326 of the USA PATRIOT Act, the distribution  
from the HSA must be reported.  
File Form 1099-SA, Distributions From an HSA, Archer  
MSA, or Medicare Advantage MSA, to report distributions  
made from a health savings account (HSA), Archer  
medical savings account (Archer MSA), or Medicare  
Aug 04, 2022  
Cat. No. 38470S  
 
If a regular contribution is made to the HSA that is  
closed, and a distribution is made to the participant, enter  
the gross distribution in box 1. If no earnings are  
the account holder's death. The FMV of the account as of  
the date of death is required to be reported in box 4.  
Follow the rules and coding above under Distribution in  
year of death and Distribution after year of death.  
distributed, enter zero in box 2. If earnings are distributed,  
enter the amount of earnings in box 2. Enter code 2 in  
box 3. See the instructions for boxes 1 through 3, later.  
Statements to Recipients  
If you are required to file Form 1099-SA, you must provide  
a statement to the recipient. For more information about  
the requirement to furnish a Form 1099-SA or acceptable  
substitute statement to recipients, see part M in the  
current General Instructions for Certain Information  
Returns.  
In addition, Form 5498-SA must be filed to report any  
rollover (qualified HSA funding distributions  
(trustee-to-trustee transfers from an IRA to an HSA under  
section 408(d)(9))) contributions to the HSA subsequently  
closed by the trustee or custodian. See the Specific  
Truncating Recipient's TIN on Payee Statements  
Death of Account Holder  
Archer MSAs and MA MSAs. When the account holder  
dies and the designated beneficiary is the surviving  
spouse, the following apply.  
Pursuant to Regulations section 301.6109-4, all filers of  
this form may truncate a recipient’s TIN (social security  
number (SSN), individual taxpayer identification number  
(ITIN), adoption taxpayer identification number (ATIN), or  
employer identification number (EIN)) on payee  
The spouse becomes the account holder of the Archer  
MSA.  
statements. Truncation is not allowed on any documents  
the filer files with the IRS. A trustee's/payer's TIN may not  
be truncated on any form. See part J in the current  
General Instructions for Certain Information Returns.  
An MA MSA is treated as an Archer MSA of the spouse  
for distribution purposes.  
Distributions from these accounts are subject to the  
rules that apply to Archer MSAs.  
Account Number  
If the designated beneficiary is not the spouse or there  
is no named beneficiary, the account ceases to be an  
MSA as of the date of death and the fair market value  
(FMV) on that date is reported.  
The account number is required if you have multiple  
accounts for a recipient for whom you are filing more than  
one Form 1099-SA. Additionally, the IRS encourages you  
to designate an account number for all Forms 1099-SA  
that you file. See part L in the current General Instructions  
for Certain Information Returns.  
If there is more than one recipient, the FMV should be  
allocated among them, as appropriate.  
If the beneficiary is the estate, enter the estate's name  
and TIN in place of the recipient's on the form.  
Distribution in year of death. If you learn of the  
account holder's death and make a distribution to the  
beneficiary in the year of death, issue a Form 1099-SA  
and enter in:  
Box 1. Gross Distribution  
Enter the total amount of the distribution. Include any  
earnings separately reported in box 2. You are not  
required to determine the taxable amount of a distribution.  
Do not report a negative amount in box 1. Do not report  
the withdrawal of excess employer contributions (and the  
earnings on them) returned to an employer as a  
Box 1, the gross distribution;  
Box 3, code 4 (see Box 3. Distribution Code, later); and  
Box 4, the FMV of the account on the date of death.  
Distribution after year of death. If you learn of the  
distribution from an employee's HSA. Do not report  
excess MA MSA contributions returned to the Secretary of  
Health and Human Services or his or her representative.  
death of the account holder and make a distribution after  
the year of death, issue a Form 1099-SA in the year you  
learned of the death of the account holder. Enter in:  
Box 2. Earnings on Excess Contributions  
Box 1, the gross distribution;  
Enter the total earnings distributed with any excess HSA  
or Archer MSA contributions returned by the due date of  
the account holder's tax return. Include this amount in  
box 1. Report earnings on other distributions only in box 1.  
Box 3, one of the following codes (see Box 3.  
Distribution Code, later):  
1—If the beneficiary is the spouse,  
4—If the beneficiary is the estate, or  
6—If the beneficiary is not the spouse or estate;  
For HSAs and Archer MSAs, if you are reporting  
earnings on a distribution of excess contributions,  
use the method under Regulations section  
TIP  
Box 4, the FMV of the account on the date of death,  
reduced by any payments from the HSA made for the  
decedent's qualified medical expenses, if paid within 1  
year after death.  
1.408-11 for calculating the net income attributable to IRA  
contributions that are distributed as a returned  
contribution. If the amount in box 2 includes earnings on  
excess contributions, enter distribution code 2 in box 3.  
HSAs. When the account holder dies, the following  
applies.  
If the designated beneficiary is the surviving spouse,  
Box 3. Distribution Code  
Enter the appropriate distribution code from the following  
list that shows the type of distribution.  
the spouse becomes the account holder of the HSA.  
If the designated beneficiary is not the surviving  
spouse, the account ceases to be an HSA on the date of  
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Instructions for Forms 1099-SA and 5498-SA (2023)  
     
Distribution Codes for Distributions From HSAs, Archer MSAs, and Medicare Advantage MSAs  
Use this code for normal distributions to the account  
holder and any direct payments to a medical service  
1—Normal distributions  
provider. Use this code if no other code applies. Also, see  
Use this code for distributions of excess HSA or Archer  
MSA contributions to the account holder.  
2—Excess contributions  
Use this code if you made distributions after the account  
holder was disabled (see section 72(m)(7)).  
3—Disability  
Use this code for payments to a decedent's estate in the  
year of death. Also use this code for payments to an  
4—Death distribution other than code 6  
estate after the year of death. Do not use with code 6. See  
5—Prohibited transaction  
See sections 220(e)(2) and 223(e)(2).  
Use this code for payments to a decedent's nonspouse  
beneficiary, other than an estate, after the year of death.  
Do not use with code 4.  
6—Death distribution after year of death to a nonspouse  
beneficiary  
Box 4. FMV on Date of Death  
Total Distribution, No Contributions  
Enter the FMV of the account on the date of death. See  
Generally, if a total distribution was made from an HSA or  
Archer MSA during the year and no contributions were  
made for that year, you need not file Form 5498-SA nor  
furnish a statement to the participant to reflect that the fair  
market value (FMV) on December 31 was zero.  
Box 5. Checkbox  
Check the box to indicate if this distribution was from an  
HSA, Archer MSA, or MA MSA.  
Death of Account Holder  
In the year an HSA, Archer MSA, or MA MSA owner dies,  
you must generally file a Form 5498-SA and furnish a  
statement for the decedent. If the designated beneficiary  
is the surviving spouse, the following apply.  
Specific Instructions for Form  
5498-SA  
File Form 5498-SA, HSA, Archer MSA, or Medicare  
Advantage MSA Information, with the IRS on or before  
May 31, 2024, for each person for whom you maintained a  
health savings account (HSA), Archer medical savings  
account (Archer MSA), or Medicare Advantage MSA (MA  
MSA) during 2023. You are required to file if you are the  
trustee or custodian of an HSA, Archer MSA, or MA MSA.  
A separate form is required for each type of plan.  
The spouse becomes the account holder of the HSA or  
Archer MSA.  
An MA MSA is treated as an Archer MSA of the spouse  
for distribution purposes, but no new contributions may be  
made to the account.  
If the designated beneficiary is not the spouse or there  
is no designated beneficiary, the account ceases to be an  
HSA, Archer MSA, or MA MSA.  
For HSA or Archer MSA contributions made between  
January 1, 2024, and April 15, 2024, you should obtain  
the participant's designation of the year for which the  
contributions are made.  
For repayment of a mistaken distribution amount, see  
HSA Mistaken Distributions, earlier. Do not treat the  
repayment as a contribution on Form 5498-SA.  
Statements to Participants  
If you are required to file Form 5498-SA, you must provide  
a statement to the participant (generally Copy B) by May  
31, 2024. You may, but you are not required to, provide  
the participant with a statement of the December 31,  
2023, FMV of the participant's account by January 31,  
2024. For more information about statements to  
participants, see part M in the 2023 General Instructions  
for Certain Information Returns.  
Rollovers  
You must report the receipt of a rollover from one Archer  
MSA to another Archer MSA, and receipt of a rollover  
from an Archer MSA or an HSA to an HSA in box 4.  
If you furnished a statement of the FMV of the account  
to the participant by January 31, 2024, and no reportable  
contributions, including rollovers, were made for 2023,  
you need not furnish another statement (or Form  
5498-SA) to the participant to report zero contributions.  
However, you must file Form 5498-SA with the IRS by  
May 31, 2024, to report the December 31, 2023, FMV of  
the account.  
Transfers  
Do not report a trustee-to-trustee transfer from one Archer  
MSA or MA MSA to another Archer MSA or MA MSA,  
from an Archer MSA to an HSA, or from one HSA to  
another HSA. For reporting purposes, contributions and  
rollovers do not include these transfers. However, see  
Box 2, later, for the reporting of a trustee-to-trustee  
transfer from an IRA to an HSA.  
Instructions for Forms 1099-SA and 5498-SA (2023)  
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If you do not furnish another statement to the  
participant because no reportable contributions  
were made for the year, the statement of the FMV  
Box 2. Total Contributions Made in 2023  
!
Enter the total HSA or Archer MSA contributions made in  
2023. Include any contribution made in 2023 for 2022.  
Also include qualified HSA funding distributions  
CAUTION  
of the account must contain a legend designating which  
information is being furnished to the IRS.  
(trustee-to-trustee transfers from an IRA to an HSA under  
section 408(d)(9)) received by you during 2023. Any  
excess employer contributions (and the earnings on them)  
withdrawn by the employer pursuant to Notice 2008-59,  
Q/A 24, available at IRS.gov/irb/  
Truncating Participant's TIN on Payee  
Statements  
Pursuant to Regulations section 301.6109-4, all filers of  
this form may truncate a participant's TIN (social security  
number (SSN), individual taxpayer identification number  
(ITIN), adoption taxpayer identification number (ATIN), or  
employer identification number (EIN)) on payee  
2008-29_IRB#NOT-2008-59, should not be reported as a  
contribution. You may, but you are not required to, report  
the total MA MSA contributions made in 2023 by the  
Secretary of Health and Human Services or his or her  
representative. Do not include amounts reported in box 4.  
statements. Truncation is not allowed on any documents  
the filer files with the IRS. A trustee's TIN may not be  
truncated on any form. See part J in the 2023 General  
Instructions for Certain Information Returns.  
Box 3. Total HSA or Archer MSA Contributions  
Made in 2024 for 2023  
Enter the total HSA or Archer MSA contributions made in  
2024 for 2023.  
Account Number  
The account number is required if you have multiple  
accounts for a recipient for whom you are filing more than  
one Form 5498-SA. Additionally, the IRS encourages you  
to designate an account number for all Forms 5498-SA  
that you file. See part L in the 2023 General Instructions  
for Certain Information Returns.  
Box 4. Rollover Contributions  
Enter rollover contributions to the HSA or Archer MSA  
received by you during 2023. These amounts are not to  
be included in box 2.  
Box 5. Fair Market Value of HSA, Archer MSA, or  
MA MSA  
Enter the FMV of the account on December 31, 2023.  
Box 1. Employee or Self-Employed Person's  
Archer MSA Contributions Made in 2023 and  
2024 for 2023  
Enter the employee's or self-employed person's regular  
contributions to the Archer MSA made in 2023 and  
through April 15, 2024, for 2023. Report gross  
contributions, including any excess contributions, even if  
the excess contributions were withdrawn. No HSA  
information is to be reported in box 1.  
Box 6. Checkbox  
Check the box to indicate if this account is an HSA, Archer  
MSA, or MA MSA.  
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Instructions for Forms 1099-SA and 5498-SA (2023)