The Employee Benefit Research Institute (EBRI) developed the EBRI HSA Database to analyze the state of, and individual behavior in, Health Savings Accounts (HSAs). The HSA database contains 5.5 million accounts with total assets of $11.4 billion as of Dec. 31, 2016. This paper is the first longitudinal study from the HSA database and supplements the annual cross-sectional analyses. It examines trends in account balances, individual and employer contributions, distributions, invested assets, and account-owner demographics from 2011-2016. Plan sponsors who wish to introduce or continue offering HSA-eligible health plans as part of their workplace benefit program can leverage this long-term view of account-holder behaviors when developing strategies to increase employee financial wellness. Average total contributions -- combined individual and employer contributions -- increased from $2,348 to $2,922 between 2011 and 2016. Overall, 63 percent of account holders withdrew funds. The average annual amount distributed was $1,771 in 2016, implying an average rollover of $1,151. Very few account owners invested their HSA balance in investments other than cash despite the tax-saving possibilities. In 2016, 4 percent had investments other than cash. Average end-of-year balances, by the year the account was opened, show that financial security increases over time. Accounts opened in 2004 (or earlier) had an average $14,873 year-end account balance, while accounts opened in 2016 had an average $1,027 year-end account balance. Annual 2016 contributions are higher the longer an account owner had an account. Individual contributions averaged $3,658 among those who opened their account in 2005, but only averaged $1,290 among those who opened their account in 2016. Older, larger accounts offer a stronger hedge against unexpected bills. Those accounts opened in 2005 had an average annual distribution of $2,756, while those only opened in 2016 took $1,051 in distributions. Over time, account owners appear to see the value in investing. In 2016, 11 percent of accounts opened in 2005 had investments other than cash, compared to only 1 percent among those opened in 2016. It is possible that rules requiring minimum balances may have prevented owners of relatively new accounts from investing as the accounts would not have reached the minimum balance requirement
