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HSA Forms for Account Holders


Welcome to our HSA Forms Center!  Here you'll find a collection of all the enrollment, maintenance, employer and closure forms you and your clients will ever need for your health savings account, all in one convenient location. 

They're all organized below by category, and if you can't find what you need please contact us

We're here to help, and you and your clients are our number one priority.  We look forward to every opportunity we have to make a difference.

 

HSA ENROLLMENT FORMS

For your convenience, we have compiled packets that contain all the forms necessary to complete the HSA application process for individuals, new groups, existing groups, and rollovers.  These packets include all relevant forms, including an overview with instructions.  Individual forms are listed below each packet.
 

HSA Enrollment Packet:  Individuals    

This packet contains:

 


 

HSA Enrollment Packet:  New Groups    

This packet contains:

 


 

HSA Enrollment Packet:  Existing Groups    

This packet contains:

 


 

HSA Rollover Packet:    

This packet contains:

 


HSA BANKING & MAINTENANCE FORMS

 HSA Deposit Form:    

Make a deposit to your HSA.

 Change of Personal Information Form:     

Update contact information or personal data on your HSA.

 Beneficiary Change Form:     

Update the beneficiary on your HSA.

 ACH Funding Form:     

Authorize automatic electronic funding into your HSA.

 

EMPLOYER FORMS
 

Request Updated Distribution Sheet:

We'll send you an updated sheet with your current census for group deposits.

Update Group Contact Information:     

Change your contact person, phone number, address, etc., or add/remove employees from company census.

 

HSA CLOSURE FORMS

 HSA Closure Form:     

Close your HSA.