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Form 1099-SA

Form name:

Distributions From an HSA, Archer MSA, or Medicare Advantage MSA

IRC Section:

6047, 220(h), 408(i), 138, 106(b)

Link to form:

Purpose of form:

Payors must file Form 1099-SA for any distributions made from a health savings account (HSA), Archer medical savings account (Archer MSA), or Medicare 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.

Information reported on form:

  • The name, address, taxpayer identification number and phone number of the trustee/payor,
  • The name, address, and taxpayer identification number of the recipient,
  • Account number,
  • Gross distribution,
  • Earnings on excess contribution,
  • Distribution code,
  • Fair market value on date of death,
  • Checkbox for HSA, Archer MSA, or MA MSA,


Please see Form 1099-SA for all other information required to be reported

Reporting threshold: 

All amounts.

Due date to recipient: 

January 31.

Due date to IRS (paper filing)

February 28.

Due date to IRS (Electronic Filing)

March 31.