AHV Forms

From this page you can download frequently requested documents for printing and viewing with Adobe Acrobat Reader.
Signup Online with our Secure Enrollment Form
Change of Address Form Request
Electronic Fund Transfer Form Request
Employer Distibution Form Request for making group deposits

You will need Adobe Acrobat Reader to view or print the application forms.

PDF Forms:

Account Rollover Checklist and Signature Forms
Brochure
Eligibility and Contributions Limitations - 2008
Eligible Expenses Partial list of eligible and non-eligible HSA expenses.
Employer Addition | Deletion Sheet
Employer Information Sheet To be completed by new groups.
HSA Application
Individual Deposit Slip
IRS Form 8889
IRS Form 8889 instructions
Process Packet Includes Eligibility and Contribution Limitations, Schedule of Fees, and Application.
RX Discount Card Print your FREE American Health Value RX card and start saving today on prescriptions.
Schedule of Fees

You will need Adobe Acrobat Reader to view or print the application forms.

* Federally Qualified HSA: To have a Federally Qualified HSA, you must purchase and maintain a high-deductible insurance policy and you cannot be covered by another low-deductible insurance policy.

* Note on compliance with your health plan: This Internet site describes services and benefits of the American Health Value HSA Account, which are subject to change without notice. It is not intended to provide legal, health, or tax advice. Consult your own legal, medical, and tax counsel for guidance on issues that may be affected by your specific circumstances.

* Please note the conditions of your plan: If you intend to use the American Health Value HSA to pay your deductible or other services covered under you health care plan, we strongly recommend that you always comply with the conditions of your plan, including pre-certification requirements.