VOYA HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENTVoya Health Savings Account Custodial Agreement • November 17th, 2022 • Connecticut
The Account Owner is establishing a Health Savings Account (an “HSA” and, with respect to the Account Owner, the “Account”), as defined in Internal Revenue Code (“Code”) Section 223, with Voya Institutional Trust Company exclusively for the purpose of paying or reimbursing Qualified Medical Expenses of the Account Owner, his or her spouse and dependents. The Account Owner represents that, unless the Account is used solely to make rollover contributions, the Account Owner is eligible to contribute to the Account; specifically, that the Account Owner: (1) is covered under a high deductible health plan (HDHP); (2) is not also covered by any other health plan that is not an HDHP (with certain exceptions for plans providing preventive care and limited types of permitted insurance and permitted coverage); (3) is not enrolled in Medicare; and (4) cannot be claimed as a dependent on another person’s tax return.
