Erika, age 39, had self-only HDHP coverage on January 1, 2011. She changed to family HDHP coverage on August 1, 2011. Erika lost HDHP coverage as of October 31, 2011. She will use the Line 3 Limitation Chart and Worksheet in Form 8889 Instructions to determine her HSA contribution limit. Click here to see her completed Form 8889 worksheet.