Just one in five business owners fully understand importantelements of health savings accounts, according to new research fromthe NationwideRetirement Institute.

Nationwide surveyed 406 U.S. business owners with 11 to 500employees in February and found that 41 percent ofbusiness owners offer their employees an HSA. Another21 percent are considering an HSA, while38 percent state they are not considering an HSA.

A striking number of millennial business owners are leading theway with HSA adoption.

Related: 4 ways to fuel HSA growth

According to the survey, 81 percent of millennialbusiness owners today offer an HSA option, compared to44 percent of Gen X and 25 percent ofboomer-owned businesses.

Nationwide announced in October that it planned to beginoffering HSAs this year.

The larger the business, the more likely it is to offer an HSA:59 percent of companies with 51 to 100 employees offer anHSA and 60 percent of companies with more than 100employees offer one, compared to only 25 percent forcompanies with 50 or fewer employees.

However, the survey also found that many of the business ownershad misconceptions around the benefits of an HSA andmisunderstandings on how HSAs operate. Among those surveyed, manydidn't understand that it's necessary to provide a high-deductiblehealth plan (HDHP) when offering an HSA, that employers cancontribute to employee plans, and HSA balances carry overyear-to-year.

Nationwide asked the survey respondents about the benefits of anHSA. According to the survey, business owners who already offer anHSA report that the main benefits are providing tax advantages(56 percent) and the ability to cover health caredeductibles and out-of-pocket expenses (58 percent).

Less than half (43 percnet) said saving for retirement is anadvantage associated with HSAs. In contrast, those who don't offerHSAs and are not considering to do so said they are unsure of theadvantages associated with HSAs.

“Health savings accounts are effective tools for business ownersand employees alike,” John Carter, president ofNationwide's retirement plan business, said in a statement. “They can supplement retirementsavings plans by promoting greater savings and easing retirementconcerns around healthcare costs, while offering special taxtreatment not found in other retirement accounts.”

In addition to misconceptions around the benefits of an HSA, agap exists in understanding that businesses must provide a HDHP tooffer an HSA.

According to the survey, 6 percent of business ownerswith 101-500 employees answered that their business offers an HSAdespite indicating they did not offer an HDHP option, which wouldnot be possible.

Looking specifically at millennial business owners, the surveyfinds that they possess a mostly solid knowledge about theimportant elements of HSAs, in addition to how HSAs can beadvantageous for them and their businesses.

However, only 31 percent of millennial business ownersknew that HSA balances carry over year-to-year.

According to Carter, Nationwide believes the “growth ofhealth savings accounts follows the same upward trajectory ofdefined contribution plans.”

“As employers become more familiar with health savings accounts,advisors need to help ensure they understand the associatedbenefits,” he said in a statement.

Read more: 

• Did you know? Amazon now takes HSA, FSApayments
• HSAs still being used primarily for spending, notsaving
• 7 FAQs about HSA eligibility