You get more out of your HSA dollars when you use them to pay for IRS-qualified medical expenses.
The dollars you contribute to employee HSAs reduce your payroll taxes.
We help your customers get the most tax savings from their HSAs.
Our HSA is compatible with many health insurance plans (typically bronze or silver) offered on public and private exchanges or online marketplaces.
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The below forms are available to help you open, access, and manage your HSA. All forms can be downloaded, printed and either mailed or faxed to our Customer Assistance Center. If you are enrolled in Internet Banking, some of these forms and related activities can be completed online.
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.
Sign up for an HSA
Click on the above link to begin enrollment.
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.
Download disclosures associated with your HSA.
Standard HSA Interest Rates and Fee Schedule
Schedule may vary based on employer relationship.
Privacy and Opt Out Notice
Download statements regarding your right to privacy.
Log in to Internet Banking to set up a transfer, or submit this form.
MSA to HSA Rollover Form
HSA Transfer/Rollover Form
IRA to HSA Transfer Form
Order Checks and Debit Cards
Log into Internet Banking to order checks and debit cards.
Excess Removal Form
Remove funds that exceed your annual contribution limit.
Distribution Reversal Form
Return funds used for non-eligible expenses.
Withdraw HSA funds.