Health Savings Account Information

Jefferson County School District Health Savings Account Information

A Health Savings Account (H.S.A.) is different and separate from your insurance.  It is an account you set up at a financial institution and it belongs to you during and after your employment with the district.  Because deposits into the Health Savings Account are not taxed, the IRS regulates how much you may contribute and how you may spend it.  The primary rule is that in order to get the tax advantage of an H.S.A. you must also be enrolled in a health plan that has high deductibles (as defined by the IRS.) After money is contributed to the H.S.A. you are able to spend it on qualifying medical expenses.  (See the list of eligible expenses below.)  The goal is to grow your account over time and save money on your insurance costs as the High Deductible plans are less expensive than the other plans. 

MODA Health Plan Evergreen PPO / Synergy  is one of the health insurance options to be available to employees and retirees for the 2017-18 coverage year.  This medical plan is the lowest priced plan available in OEBB, and also has the highest deductibles.  MODA Plan Evergreen qualifies under the IRS rules so you may also open a Health Savings Account and you may begin to contribute pretax dollars into it! The maximum amount that may be contributed into the H.S.A. each year is listed below. That amount includes both the employee and employer contribution.  The contribution amount may be changed at any time during the year.  There is no maximum amount that may be spent for medical expenses for you and your tax dependents.  


You must establish that you are not: 1) Being claimed as a dependent on another person's tax return.  2) Covered by any other health plan other than a qualified High Deductible Health Plan or 3) Enrolled in Medicare.


Employees that have selected plan Evergreen may be eligible for a district contribution into the H.S.A. The district will deposit the difference between the CAP and the plan combination into your Health Savings Account each month.   If you are generally healthy and have very few medical expenses, that money will continue to accrue year after year.    

REMEMBER:  If you choose Moda Plan Evergreen, you are not finished with your enrollment!

 If you used an H.S.A, account last year, the district will assume you want to contribute to the same account this year.  However, if this is the first time you are enrolling in the high deductible plan with an H.S.A. you must also open a Health Savings Account and turn the enrollment form into your payroll department before the payroll cutoff date.  Otherwise we will just hold your contribution until you turn your form. Our district requires you establish an H.S.A. account with American Fidelity, Mid Oregon Credit Union  or Optum. Most financial institutions offer debit cards to access your H.S.A. and you do NOT need to submit receipts to the bank.  (However you are accountable to the IRS, so you may want to keep receipts at home in case you are audited in the future.) Then be sure to send the information to Nancy Anderson in payroll at the District office.


 If you are contributing into a section 125 plan now, and choose to open a Health Savings Account, you need to know the IRS again has rules regulating your tax liability.  The IRS will NOT allow you to have money in a Section 125 while contributing to a Health Savings Account.  This is very important because on the last day of your Section 125 plan year (December 31, 2017) you must not have any money remaining in your Section 125 Flex plan.   The district will "hold in trust" your H.S.A. contributions during the run out period for your Section 125, (January 2018 if your Flex dollars were used up in time, or 90 days into the new year if you had even $0.01 in your Flex.)  Please talk to Todd at American Fidelity if you have any questions at all about coordinating a smooth transition from Flex to H.S.A.   



  • $3,400 If the account owner (employee) has individual coverage on MODA Plan Evergreen.
  • $6,750 If the account owner (employee) has more than just the employee covered on MODA Plan Evergreen.
  • $1,000 Catch-up-only participants who are age 55 or older


  • $3,450 If the account owner (employee) has individual coverage on MODA Plan Evergreen.
  • $6,900 If the account owner (employee) has more than just the employee covered on MODA Plan Evergreen.
  • $1,000 Catch-up-only participants who are age 55 or older


View IRS Publication 969 Regarding Health Savings Accounts

Department of The Treasury Resource

Department of The Treasury H.S.A. brochure

Common Eligible and Ineligible H.S.A. Expenses

If you elect to establish a Health Savings Account Jefferson County School District will only accept HSA accounts from three entitites as of the 2017-2018 school year. you must first visit the bank and open an account.  Then complete and send to Nancy Anderson in payroll at the District office.



American Fidelity Information
Todd Wells                             
Account Manager
American Fidelity Assurance Company
Phone: 1-877-293-1090 Ext 13
Fax: 1-877-295-1091

American Fidelity Website

Request for dependent debit card form

Click here to access American Fidelity Forms including enrollment application to Nancy Anderson – Payroll, do not submit online)



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