An eligible individual can establish an HSA (or multiple HSAs) with a qualified HSA trustee or custodian (insurance company, bank, or similar financial institution) in much the same way an IRA is established. No permission or authorization is required from IRS. There is no requirement that the individual have earned income. If employed, an eligible individual may establish an HSA with or without involvement of the employer. Joint HSAs between a husband and wife are not allowed; each spouse who is an eligible individual who wants to contribute to an HSA must have a separate HSA.

HSA funds may be invested in the same type of investments approved for IRAs. They may not invest in life insurance contracts or collectibles. Account beneficiaries are prohibited from entering into the same type of “prohibited transactions” as applicable to IRAs. Amounts treated as distributed because of a prohibited transaction are not considered used to pay for qualified medical expenses and must be included in gross income and are subject to an additional 20% penalty.