Note: For any forms that do not need to be sent with a check, you may send those completed forms to service@myameriflex.com to ensure timely processing. Please note that incomplete forms may result in delays.
For forms that do require a check to be sent with them, you must mail those completed forms to the address indicated on the form.
| Form Name | Use form when... |
| HSA Account Closure Form | You are looking to close your HSA |
| HSA Contribution Correction Form | You need to make a correction to your contribution to your HSA |
| HSA Distribution Reversal Form | You need to make a distribution reversal to your HSA (i.e. an overpay correction, a withdrawal error, or an account closed in error) |
| You need to rollover funds from a prior third-party administrator into your existing HSA account | |
| HSA Transfer Form | You need to transfer your current HSA funds from a prior third-party administrator |
| HSA Individual Contribution Form |
You need to make a personal contribution to your HSA |
| HSA Death Distribution Request Form |
You need to to authorize a distribution of assets from a decedent’s HSA, directly to you as the beneficiary |
| HSA Beneficiary Form |
You need to add/update beneficiary information for an already existing HSA (you may also add/update this information within the Participant Portal) |
| IRA to HSA Transfer Form |
You need to make a one-time transfer of funds from your IRA into your HSA. |
