Skip to main content
Capital Blue Cross Learning Center

HSA Combined Tax Statement

  1. Last updated
  2. Save as PDF
The HSA Combined Tax Statement consolidates all of your HSA tax reporting, including the information needed to prepare Form 8889. Here's what you need to know about the statements and tips regarding your HSA and filing your taxes.

The HSA Combined Statement includes your 1099-SA and 5498-SA reporting information.

What is Form 1099-SA? The 1099-SA section details all withdrawals made from your HSA in a given tax year.

What is Form 5498-SA? The 5498-SA section summarizes your contributions for a given tax year and what your balance was on December 31 of that year.

Why am I receiving this? This form is informational only. It allows you to compare what you report on your tax return against what Capital Blue Cross will report to the IRS.

What action do I need to take? Just make sure this form matches the information in your Form 5498-A and keep this form in your tax files. Consult with your tax adviser or the IRS if you have any questions about your tax filing. You can reach an IRS tax adviser by calling 1-800-829-1040 or visiting http://www.irs.gov/.

What if I make HSA contributions after December 31? Typically, you have until April 15 of the following year to make contributions to your HSA that count toward the current tax year, and you can easily make an online contribution through the Online Member Service Center. The 2025 contribution limits are $4,150 per individual and $8,300 per family. An additional $1,000 can be contributed if you are at least 55. 

If you make contributions to your HSA after Capital Blue Cross issues your initial 5498-SA but before April 15, Capital Blue Cross will issue a corrected 5498-SA to you after the filing deadline to reflect any additional HSA contributions you made.

If you have questions about your HSA, contact Capital Blue Cross customer service.

How to prepare for your HSA tax filing

Your employer will send a form

  • If you or your employer made pre-tax contributions to your HSA, it will be noted on the W-2 Form that you receive from your employer.
  • W-2 Forms for a tax year must be mailed by January 31 of the following year.

You or your tax adviser will complete a form

  • You will need to complete Form 8889-Health Savings Accounts using the applicable information from the 1099-SA and the W-2 Forms.
  • Form 8889 and its instructions are available from your tax advisor, local library, online at http://www.irs.gov/, or by calling the IRS at 800-829-3676.

If you need assistance, contact a qualified tax adviser or the IRS at http://www.irs.gov/ or by calling 800-829-1040.