| 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. |
Frequently Asked Questions
Q: How do I find my HSA Account Number?
A: Your full HSA Account Number, Routing Number, and other account information can be found on our Participant Portal by following these steps.
Q: I have funds in a Health Savings Account (HSA) with a different custodian. How do I transfer these funds into my Ameriflex HSA?
A: Please download, complete, and sign the HSA Transfer Form. Please ensure that you submit this completed form to the custodian currently holding your assets. Please do not return this form to Ameriflex. Your current custodian will then submit this form to Ameriflex along with a check for the funds being transferred to your account with us.
The estimated timeframe for completing this process is 4-6 weeks. This timeframe often depends on the processing timeframes set forth by the custodian who is transferring your funds to Ameriflex.
Q: I have a check that my previous HSA custodian issued directly to me. How do I deposit these funds into my Ameriflex HSA?
A: Please download, complete, and sign the HSA Rollover Form. Then, send the completed form along with the check from the previous custodian to Ameriflex. Please ensure that your check is endorsed to Ameriflex. You can find our mailing address in the Customer Instructions section of this form.
Please note the following restrictions on HSA rollovers:
- The funds you receive from the distributing HSA or HSA must be deposited into an HSA within 60 days after you receive them. When counting the 60 days, include weekends and holidays. Generally, there are no exceptions to the 60-day rule, and the IRS cannot grant extensions.
- You are entitled to one distribution per year per HSA, which may be rolled over. Twelve (12) months must pass after receipt of one distribution, which you roll over, before you may take another distribution from the same HSA to roll over.
Q: How do I add funds to my Ameriflex HSA (make a contribution)?
A: Refer to this article for full details on how to contribute to your HSA.
Q: I mistakenly contributed funds to my HSA. How can this be corrected?
A: Sometimes, due to payroll issues or due to simple oversights, you or your employer may accidentally contribute too much or contribute when you're no longer eligible.
For example:
- You may have gone over the IRS annual contribution limit.
- You may have contributed for a tax year you weren't eligible for.
- You may have intended to contribute to last year or next year, but the contribution was applied to the wrong year.
If any of these apply to you, please download, complete, and sign the HSA Individual Contribution Correction Form. Please make sure to select the reason for the correction in section 2, as well as the method of the correction in section 3 of the form.
Q: I filed a claim or used my Ameriflex card in error, or a provider issued me a refund for a service that I previously paid for, and I need to return the funds to my HSA. How can I return these funds to my account?
A: Please download, complete, and sign the HSA Distribution Reversal Form. Then mail the completed form, along with a check payable to Ameriflex HSA, to the address listed on the form. If you're sending us a check from your provider, please ensure it is endorsed to Ameriflex HSA.
