The below forms are available to help you open, access, and manage your HSA. Forms can be emailed, mailed or faxed to our Client Assistance Center. Some of these activities can be completed in your online account.
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Account Set-up Forms
Authorized Signer Revoked
Remove an authorized signer from an account.
Designation of Beneficiaries
Designate, change or remove a beneficiary.
Change of Address
Use the form or log in to your account and click "Profile" to change your address.
Disclosures, Rates and Fees
Contribution and Withdrawal Forms
Log in to your account to set up a transfer, or submit this form.
Excess Removal Form
Remove funds that exceed your annual contribution limit.
Distribution Reversal Form
Return funds used for non-eligible expenses or overpayments.
Withdraw HSA funds.
Transfer Out Instructions
Steps for transferring to a new custodian.