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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 Advantage MSA (MA MSA). The distribution may have
unless otherwise noted. been paid directly to a medical service provider or to the
account holder. A separate return must be filed for each
Future Developments plan type.
For the latest information about developments related to
Forms 1099-SA and 5498-SA and their instructions, such Transfers
as legislation enacted after they were published, go to Do not report a trustee-to-trustee transfer from one Archer
IRS.gov/Form1099SA and IRS.gov/Form5498SA. MSA or MA MSA to another Archer MSA or MA MSA,
from an Archer MSA to an HSA, or from one HSA to
Reminders another HSA. For reporting purposes, contributions and
In addition to these specific instructions, you should also rollovers do not include transfers.
use the 2023 General Instructions for Certain Information
Returns. Those general instructions include information HSA Mistaken Distributions
about the following topics. If amounts were distributed during the year from an HSA
• Who must file. because of a mistake of fact due to reasonable cause, the
• When and where to file. account beneficiary may repay the mistaken distribution
• Electronic reporting. no later than the due date of the tax return (not counting
• Corrected and void returns. extensions) following the first year the account beneficiary
• Statements to recipients. knew or should have known the distribution was a
• Taxpayer identification numbers (TINs). mistake. For example, the account beneficiary
• Backup withholding. reasonably, but mistakenly, believed that an expense was
• Penalties. a qualified medical expense and was reimbursed for that
• Other general topics. expense from the HSA. The account beneficiary then
repays the mistaken distribution to the HSA.
You can get the general instructions from IRS.gov/
1099GeneralInstructions IRS.gov/Form1099SA, , and Under these circumstances, the mistaken distribution is
IRS.gov/Form5498SA. not included in gross income, is not subject to the
Continuous-use form and instructions. Form 1099-SA additional 20% tax, and the repayment is not subject to
and its instructions are continuous use. Both the form and the excise tax on excess contributions. Do not treat the
instructions will be updated as needed. For the most repayment as a contribution on Form 5498-SA, HSA,
recent version, go to IRS.gov/Form1099SA. Archer MSA, or Medicare Advantage MSA Information.
Online fillable forms. Due to the very low volume of As the trustee or custodian, you do not have to
paper Forms 1099-SA and 5498-SA received and TIP allow beneficiaries to return a mistaken
processed by the IRS each year, these forms have been distribution to the HSA. However, if you do allow
converted to an online fillable format. You may fill out the the return of the mistaken distribution, you may rely on the
forms, found online at IRS.gov/Form1099SA and IRS.gov/ account beneficiary's statement that the distribution was
Form5498SA, and send Copy B to the recipient. For filing in fact a mistake. See Notice 2004-50, 2004-33 I.R.B.
with the IRS, follow the applicable procedures if you are 196, Q/A-76, available at IRS.gov/irb/
required to file electronically. For Forms 1099-SA and 2004-33_IRB#NOT-2004-50. Do not report the mistaken
5498-SA only, if due to a low volume of recipients, you distribution on Form 1099-SA. Correct any filed Form
are filing the form(s) on paper, you can send in the 1099-SA with the IRS and the account beneficiary as soon
black-and-white Copy(ies) A with a Form 1096 that you as you become aware of the error. See Corrected Returns
also printed from the IRS website. on Paper Forms in the current General Instructions for
Certain Information Returns for more information.
Specific Instructions for Form
HSA Closure Under the USA PATRIOT Act
1099-SA If an HSA is closed at any time by the HSA trustee or
File Form 1099-SA, Distributions From an HSA, Archer custodian due to a failure of the participant to satisfy the
MSA, or Medicare Advantage MSA, to report distributions Customer Identification Program requirements described
made from a health savings account (HSA), Archer in section 326 of the USA PATRIOT Act, the distribution
medical savings account (Archer MSA), or Medicare from the HSA must be reported.

Aug 04, 2022 Cat. No. 38470S

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If a regular contribution is made to the HSA that is the account holder's death. The FMV of the account as of
closed, and a distribution is made to the participant, enter the date of death is required to be reported in box 4.
the gross distribution in box 1. If no earnings are Follow the rules and coding above under Distribution in
distributed, enter zero in box 2. If earnings are distributed, year of death and Distribution after year of death.
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
In addition, Form 5498-SA must be filed to report any If you are required to file Form 1099-SA, you must provide
rollover (qualified HSA funding distributions a statement to the recipient. For more information about
(trustee-to-trustee transfers from an IRA to an HSA under the requirement to furnish a Form 1099-SA or acceptable
section 408(d)(9))) contributions to the HSA subsequently substitute statement to recipients, see part M in the
closed by the trustee or custodian. See the Specific current General Instructions for Certain Information
Instructions for Form 5498-SA, later. Returns.

Death of Account Holder Truncating Recipient's TIN on Payee Statements
Pursuant to Regulations section 301.6109-4, all filers of
Archer MSAs and MA MSAs. When the account holder this form may truncate a recipient’s TIN (social security
dies and the designated beneficiary is the surviving number (SSN), individual taxpayer identification number
spouse, the following apply. (ITIN), adoption taxpayer identification number (ATIN), or
• The spouse becomes the account holder of the Archer employer identification number (EIN)) on payee
MSA. statements. Truncation is not allowed on any documents
• An MA MSA is treated as an Archer MSA of the spouse the filer files with the IRS. A trustee's/payer's TIN may not
for distribution purposes. be truncated on any form. See part J in the current
• Distributions from these accounts are subject to the General Instructions for Certain Information Returns.
rules that apply to Archer MSAs.
If the designated beneficiary is not the spouse or there Account Number
is no named beneficiary, the account ceases to be an The account number is required if you have multiple
MSA as of the date of death and the fair market value accounts for a recipient for whom you are filing more than
(FMV) on that date is reported. one Form 1099-SA. Additionally, the IRS encourages you
If there is more than one recipient, the FMV should be to designate an account number for all Forms 1099-SA
allocated among them, as appropriate. that you file. See part L in the current General Instructions
If the beneficiary is the estate, enter the estate's name for Certain Information Returns.
and TIN in place of the recipient's on the form.
Box 1. Gross Distribution
Distribution in year of death. If you learn of the
account holder's death and make a distribution to the Enter the total amount of the distribution. Include any
beneficiary in the year of death, issue a Form 1099-SA earnings separately reported in box 2. You are not
and enter in: required to determine the taxable amount of a distribution.
• Box 1, the gross distribution; Do not report a negative amount in box 1. Do not report
• Box 3, code 4 (see Box 3. Distribution Code, later); and the withdrawal of excess employer contributions (and the
• Box 4, the FMV of the account on the date of death. earnings on them) returned to an employer as a
distribution from an employee's HSA. Do not report
Distribution after year of death. If you learn of the
excess MA MSA contributions returned to the Secretary of
death of the account holder and make a distribution after
Health and Human Services or his or her representative.
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;
• Box 3, one of the following codes (see Box 3. Enter the total earnings distributed with any excess HSA
Distribution Code, later): or Archer MSA contributions returned by the due date of
the account holder's tax return. Include this amount in
1—If the beneficiary is the spouse, box 1. Report earnings on other distributions only in box 1.
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
• Box 4, the FMV of the account on the date of death, TIP earnings on a distribution of excess contributions,
reduced by any payments from the HSA made for the use the method under Regulations section
decedent's qualified medical expenses, if paid within 1 1.408-11 for calculating the net income attributable to IRA
year after death. contributions that are distributed as a returned
contribution. If the amount in box 2 includes earnings on
HSAs. When the account holder dies, the following excess contributions, enter distribution code 2 in box 3.
applies.
• If the designated beneficiary is the surviving spouse,
the spouse becomes the account holder of the HSA. Box 3. Distribution Code
• If the designated beneficiary is not the surviving Enter the appropriate distribution code from the following
spouse, the account ceases to be an HSA on the date of list that shows the type of distribution.

-2- Instructions for Forms 1099-SA and 5498-SA (2023)

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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
Distribution after year of death, earlier.
Use this code for distributions of excess HSA or Archer
2—Excess contributions
MSA contributions to the account holder.
Use this code if you made distributions after the account
3—Disability
holder was disabled (see section 72(m)(7)).
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
Death of Account Holder, earlier.
5—Prohibited transaction See sections 220(e)(2) and 223(e)(2).
Use this code for payments to a decedent's nonspouse
6—Death distribution after year of death to a nonspouse
beneficiary, other than an estate, after the year of death.
beneficiary
Do not use with code 4.

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
Death of Account Holder, earlier. Archer MSA during the year and no contributions were
made for that year, you need not file Form 5498-SA nor
Box 5. Checkbox furnish a statement to the participant to reflect that the fair
Check the box to indicate if this distribution was from an market value (FMV) on December 31 was zero.
HSA, Archer MSA, or MA MSA.
Death of Account Holder
Specific Instructions for Form In the year an HSA, Archer MSA, or MA MSA owner dies,
you must generally file a Form 5498-SA and furnish a
5498-SA statement for the decedent. If the designated beneficiary
File Form 5498-SA, HSA, Archer MSA, or Medicare is the surviving spouse, the following apply.
Advantage MSA Information, with the IRS on or before • The spouse becomes the account holder of the HSA or
May 31, 2024, for each person for whom you maintained a Archer MSA.
health savings account (HSA), Archer medical savings • An MA MSA is treated as an Archer MSA of the spouse
account (Archer MSA), or Medicare Advantage MSA (MA for distribution purposes, but no new contributions may be
MSA) during 2023. You are required to file if you are the made to the account.
trustee or custodian of an HSA, Archer MSA, or MA MSA. If the designated beneficiary is not the spouse or there
A separate form is required for each type of plan. is no designated beneficiary, the account ceases to be an
For HSA or Archer MSA contributions made between HSA, Archer MSA, or MA MSA.
January 1, 2024, and April 15, 2024, you should obtain
the participant's designation of the year for which the Statements to Participants
contributions are made. If you are required to file Form 5498-SA, you must provide
a statement to the participant (generally Copy B) by May
For repayment of a mistaken distribution amount, see
31, 2024. You may, but you are not required to, provide
HSA Mistaken Distributions, earlier. Do not treat the
the participant with a statement of the December 31,
repayment as a contribution on Form 5498-SA.
2023, FMV of the participant's account by January 31,
Rollovers 2024. For more information about statements to
participants, see part M in the 2023 General Instructions
You must report the receipt of a rollover from one Archer
for Certain Information Returns.
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
Transfers contributions, including rollovers, were made for 2023,
Do not report a trustee-to-trustee transfer from one Archer you need not furnish another statement (or Form
MSA or MA MSA to another Archer MSA or MA MSA, 5498-SA) to the participant to report zero contributions.
from an Archer MSA to an HSA, or from one HSA to However, you must file Form 5498-SA with the IRS by
another HSA. For reporting purposes, contributions and May 31, 2024, to report the December 31, 2023, FMV of
rollovers do not include these transfers. However, see the account.
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) -3-

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If you do not furnish another statement to the Box 2. Total Contributions Made in 2023
! participant because no reportable contributions Enter the total HSA or Archer MSA contributions made in
CAUTION were made for the year, the statement of the FMV
2023. Include any contribution made in 2023 for 2022.
of the account must contain a legend designating which Also include qualified HSA funding distributions
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
Truncating Participant's TIN on Payee excess employer contributions (and the earnings on them)
Statements withdrawn by the employer pursuant to Notice 2008-59,
Pursuant to Regulations section 301.6109-4, all filers of Q/A 24, available at IRS.gov/irb/
this form may truncate a participant's TIN (social security 2008-29_IRB#NOT-2008-59, should not be reported as a
number (SSN), individual taxpayer identification number contribution. You may, but you are not required to, report
(ITIN), adoption taxpayer identification number (ATIN), or the total MA MSA contributions made in 2023 by the
employer identification number (EIN)) on payee Secretary of Health and Human Services or his or her
statements. Truncation is not allowed on any documents representative. Do not include amounts reported in box 4.
the filer files with the IRS. A trustee's TIN may not be
Box 3. Total HSA or Archer MSA Contributions
truncated on any form. See part J in the 2023 General
Instructions for Certain Information Returns. Made in 2024 for 2023
Enter the total HSA or Archer MSA contributions made in
Account Number 2024 for 2023.
The account number is required if you have multiple
accounts for a recipient for whom you are filing more than Box 4. Rollover Contributions
one Form 5498-SA. Additionally, the IRS encourages you Enter rollover contributions to the HSA or Archer MSA
to designate an account number for all Forms 5498-SA received by you during 2023. These amounts are not to
that you file. See part L in the 2023 General Instructions be included in box 2.
for Certain Information Returns.
Box 5. Fair Market Value of HSA, Archer MSA, or
Box 1. Employee or Self-Employed Person's MA MSA
Archer MSA Contributions Made in 2023 and Enter the FMV of the account on December 31, 2023.
2024 for 2023
Enter the employee's or self-employed person's regular Box 6. Checkbox
contributions to the Archer MSA made in 2023 and Check the box to indicate if this account is an HSA, Archer
through April 15, 2024, for 2023. Report gross MSA, or MA MSA.
contributions, including any excess contributions, even if
the excess contributions were withdrawn. No HSA
information is to be reported in box 1.

-4- Instructions for Forms 1099-SA and 5498-SA (2023)

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