*Annual Percent Yield based on rates current as of February 19, 2013. See all of our rates and fees
Healthcare Reform and HSAs
Please note: You will need Adobe Reader to view our forms. If you do not have Adobe Reader installed on your computer, please click here for a free download of the program.
To view employer forms, click here.
Sign up for an HSA online
Click on the above link to sign up for an HSA today, or enroll by mail.
Account Information Change Form
Change your name, designation of beneficiary or authorized signer.
Log in to Internet Banking to add an Authorized Signer to your account, or complete this form.
Authorized Signer Revoked
Remove an authorized signer from an account.
Designation of Beneficiaries
Designate, change or remove a beneficiary.
Log in to your Internet Banking account and click “Profile” to change your address.
Contribution Form Make a contribution online, or submit this form.
Transfers & Rollovers
MSA to HSA Rollover Form HSA Transfer/Rollover FormIRA to HSA Transfer Form
Order Checks and Debit Cards Complete the form through Internet Banking. Excess Removal FormRemove funds that exceed the contribution limit. Distribution Reversal FormReturn funds used for non-eligible expenses. Withdrawal FormWithdraw HSA funds.
E-Sign AgreementDownload information on electronic recordkeeping of disclosures, documents and statements. Account Disclosures Download disclosures associated with your HSA. Interest Rates and Service FeesOnline Banking Agreement Download the agreement terms associated with using Internet Banking.
Privacy and Opt Out NoticeDownload statements regarding your right to privacy.
IRS Form 1099-SAReports your HSA distributions. IRS Form 5498-SAReports your HSA contributions. Instructions for IRS Forms 1099-SA and 5498-SA IRS Form 8853 File your MSA contributions and distributions. Instructions for IRS Form 8853IRS Form 8889File HSA contributions, distributions and tax deductions. Instructions for IRS Form 8889
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Mailing AddressPO Box 939Sheboygan, WI 53082-0939
Additional Contact Information
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HSA Bank is a division of Webster Bank, N.A., Member FDIC
Learn about FDIC insurance coverage.