The following is my understanding, and not necessarily correct. HSA is a Health Spending Account. It is looser than a FSA. HSA's I think are only available with certain types of medical insurance, maybe only high deductible plans.
HSA money was direct-deposited into an account, pretax dollars, from every paycheck. In 2013, for a family, the maximum allowable amount by the IRS to deposit to an HSA was $6500 for the year, so $250 every 2 weeks. I received a debit card and a checkbook for the account. The idea of the HSA is to pay co-pays and medical bills with the debit card or checkbook. I did neither. I payed with my regular credit card, but kept track of the amounts spent. Periodically I wrote a check for the HSA to reimburse myself from the HSA pretax account, from what I had already spent on healthcare with my normal credit card.
It worked because my wife has not studied my online only pay stubs to understand each line of the deductions. She does pay the bills, but all she sees is the bank's statement showing the amount deposited to our checking account every 2 weeks.
Going forward, now that I have lost the HSA with new insurance, I suppose I could just add another checking account to have a small portion of my check placed into. The fear of having a "secret" account is getting caught having an account only in my name. Banks like to always send paperwork to the house.
After 9/11, the government made it more difficult to open a bank account. While trying to have an affair, I went to the bank with my passport, and mail addressed to me, but with my work address. That was not good enough. They wanted a driver's licence.