How to Fill Out and Submit the Paylocity HSA Transfer Form

The Paylocity HSA transfer form moves your existing health savings account balance from your current custodian to the custodian linked to your Paylocity benefits. You fill it out, send it to the institution that currently holds the money, and that institution ships the funds directly to the receiving custodian. Done right, the whole thing takes two to six weeks and stays tax-free.

Pick Trustee-to-Trustee, Not Rollover

The form asks you to choose between a trustee-to-trustee transfer and a rollover. This single box drives everything else.

A trustee-to-trustee transfer sends the money straight from one custodian to the other. You never touch it. The IRS does not treat the movement as a distribution, there is no limit on how many you can do in a year, and the sending custodian does not report it on Form 1099-SA.¹ You also do not report it on your tax return.²

A rollover means the old custodian cuts a check to you. You then have 60 days to deposit it into the new HSA. Miss the deadline and the entire amount becomes a taxable distribution, with an added 20 percent tax if you are under 65 and not disabled. You can only do one rollover per 12-month period; a second one inside that window is fully taxable.³

For almost every situation, trustee-to-trustee is the right choice. It erases the 60-day deadline, the once-a-year cap, and the tax paperwork. Check that box unless you have a specific reason to take possession of the funds. Neither method counts toward your annual HSA contribution limit.⁴

What to Gather Before You Fill It Out

Have these in front of you:

The exact legal name, mailing address, and phone number of your current HSA custodian. A recent statement or the account details page in the portal will have them.
Your account number at the old custodian, copied character by character. One wrong digit stalls the transfer for weeks.
The receiving custodian’s name and your new account number. Paylocity partners with third-party custodians to hold HSA funds, so check your enrollment documents or the benefits section of your Paylocity portal to see whether yours is WEX, a bank, or another entity. The form needs the custodian’s information, not Paylocity’s corporate address.
Your Social Security number. Both institutions use it to verify ownership.

Sell Your Investments First

If your old HSA holds mutual funds or other investments, you almost certainly need to sell them and sit in cash before the transfer can process. Most custodians do not accept in-kind transfers of securities because the investment lineups differ between providers.⁵ Turn off any automatic investment settings in the old account too, so your cash does not get reinvested while the transfer is pending.

Full Balance or Partial

The form will ask whether you want to move everything or a specific dollar amount. A full transfer usually closes the old account and may trigger a closure fee. A partial transfer keeps the account open, but some custodians require a minimum remaining balance. HealthEquity, for example, requires at least $25 to stay in the account and charges up to $25 to process a partial transfer out.⁶

Filling Out the Form

You can usually find the form in your Paylocity employee portal under benefits or resources. Some employers post it in a shared document library or link out to the custodian’s site. If you cannot find it, ask HR or your benefits administrator for a copy.

Work through the fields in order:

Account holder information: your full legal name, Social Security number, date of birth, and contact details. Use the name as it appears on your current HSA records.
Current custodian section: the institution’s name and address and your account number there.
Receiving custodian section: the name of your Paylocity-linked custodian and your new HSA account number. Double-check this against your enrollment documents.
Transfer type: select Trustee-to-Trustee Transfer.
Amount: write “full balance” or enter a specific dollar figure. If you write a dollar amount on what you meant as a full-balance transfer, the custodian may treat it as partial, so use the language the form provides.
Signature: sign exactly as your name appears on file with the current custodian. A mismatched signature is one of the most common reasons transfers get rejected.

Some custodians require a medallion signature guarantee rather than a plain signature, particularly on larger balances. A medallion guarantee is not a notarization. You get one from a bank or brokerage firm that participates in a recognized medallion program. If the form has a medallion box, stop by your bank’s branch before mailing.

Where to Send It

Send the completed form to your current HSA custodian, not to Paylocity and not to the receiving custodian. The institution holding your money has to authorize the release, so it needs the paperwork. Some custodians accept digital uploads through their online portal; others want a physical form by mail. If you mail it, use certified mail or another trackable service so you have proof of delivery.

Once the current custodian verifies your identity and account details, it will issue an electronic transfer or mail a check payable to the receiving custodian. You should get a confirmation or reference number. Hold onto it in case you need to follow up.

How Long It Takes

Plan on two to six weeks after the old custodian receives the form. Fidelity estimates two to five weeks for incoming transfers;⁷ Optum Bank quotes three to six weeks.⁵ The spread depends on how quickly your old custodian processes the request.

During that window, the funds may disappear from the old account before they appear in the new one. That gap is normal. Check your Paylocity dashboard periodically; the deposit will show up as a transfer-in transaction. You can keep making new contributions to your Paylocity HSA while the transfer is in flight, as long as you stay inside the annual limit.

Fees from Your Old Custodian

The receiving side of an HSA transfer is free. The fees come from the custodian you are leaving. A full-balance transfer usually closes the old account, and most custodians charge a closure fee. HealthEquity and HSA Bank each charge $25 to close an account.⁸ HealthEquity applies that fee automatically when all funds leave the account, even if you did not explicitly request closure.⁹ Pull your old custodian’s fee schedule before you initiate the transfer so the deduction does not catch you off guard.

If your custodian requires a medallion signature guarantee, you may also pay a small fee at the bank providing it, though many banks offer the service free to their own account holders.

Contribution Limits Still Apply

Transferred funds do not count toward your annual contribution limit, but anything you contributed to the old HSA during the current tax year still does. For 2026, the IRS caps HSA contributions at $4,400 for self-only coverage and $8,750 for family coverage, with an extra $1,000 catch-up for anyone 55 or older.¹⁰ Your old custodian reports prior contributions to the IRS, and your new custodian tracks anything deposited after the transfer. If the combined total goes over, you owe a 6 percent excise tax on the excess every year it stays in the account, reported on Form 5329.¹¹

Tax Reporting After the Transfer

A trustee-to-trustee transfer generates almost no paperwork at tax time. The old custodian does not issue a 1099-SA for the move, and you do not report it on Form 8889.¹ The receiving custodian records the incoming funds internally, but to the IRS the money simply moved between two pockets of the same tax-advantaged wrapper.

A rollover is different. The old custodian reports the payout on Form 1099-SA as a distribution, and you then report the rollover on Form 8889, Line 14b, to show the IRS the money went back into an HSA within 60 days.² Skip Line 14b and the IRS may treat the distribution as taxable income plus the 20 percent additional tax.³

Either way, the receiving custodian will send you Form 5498-SA after year-end. Rollover amounts appear in Box 4.¹² You do not file it, but keep it with your tax records in case the IRS ever asks about the transaction.

If Something Goes Wrong

If the funds land in the wrong account, the wrong amount gets sent, or the custodian processes a transfer as a distribution by mistake, you have options, but timing matters.

For a clear-error mistaken distribution, IRS guidance lets you return the funds to an HSA by April 15 of the year after you discovered the mistake. A properly corrected mistaken distribution is not included in your gross income and does not trigger the 20 percent penalty. The custodian should not report a corrected mistaken distribution on Form 1099-SA, and if one already went out, it should issue a corrected form.

Custodians are not required to accept returned mistaken distributions. If yours refuses, the fallback is to treat the amount as a rollover and get it into an HSA within 60 days, which burns your one rollover for the 12-month period. If you have already used your rollover, the distribution gets reported on Form 8889, and you would look for qualified medical expenses to offset the tax.

The reliable way to avoid every one of these problems is to select trustee-to-trustee transfer on the form in the first place. When the money never passes through your hands, there is nothing to misclassify.

1
Internal Revenue Service. Instructions for Forms 1099-SA and 5498-SA
2
Internal Revenue Service. Instructions for Form 8889
3
Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts
4
HSA Bank. Transfer or Rollover HSA Funds
5
Optum Bank. Transfer Your HSA
6
HealthEquity. HSA – Contributions and Transfers
7
Fidelity Investments. Transfer a Health Savings Account (HSA) to Fidelity
8
HSA Bank. Health Savings Account Fee and Interest Rate Schedule
9
TechTarget. Health Savings Accounts Come With Unexpected Fees, CFPB Reports
10
Internal Revenue Service. Internal Revenue Bulletin 2025-21
11
Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Accounts
12
Internal Revenue Service. Form 5498-SA