OPEN NEW ACCOUNT ONLINE

FREE RX CARD

HEALTH SAVINGS ACCOUNT FORMS

• NEW ENROLLMENT
• Process Packet – Includes Eligibility & Contribution Limits, Schedule of Fees, & Application
• Schedule of Fees
• HSA Application
• HSA Rollover Packet – Complete this packet if you have an existing HSA you would like to rollover to American Health Value.
• Employer Information Sheet – To be completed by new groups


• INDIVIDUAL ACCOUNT MAINTENANCE FORMS
• Deposit Slip
• Request Change of Address Form
• Request Electronic Funds Transfer Form


• EMPLOYER ACCOUNT MAINTENANCE FORMS
• Employer Addition/Deletion Change Sheet – For reporting changes in employee census.
• Request Employer Distribution Sheet - For preparing group deposits


• TAX FORMS
• Form 8889
• Form 8889 Instructions
• Review HSA Guidance and Legislation
• Understanding Your Tax Forms (1099-SA & 5498-SA)