| Form Name | Use form when... |
| HSA Account Closure Form | You are looking to close your HSA |
| HSA Authorized Signer Form | You need to add an individual who will be able to use your card and/or checks with your existing HSA |
| HSA Beneficiary Form | You need to change a beneficiary on your existing 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) |
|
HSA Rollover Form |
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 Forms Explained
This chart gives a short explanation of our core HSA forms and can help you decide which form will best serve your needs.
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Updated 4 weeks ago
