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Designation of Beneficiaries Form. FORM DesBeneficiary 4892 092810. Instructions: Please complete this form and mail or fax to: HSA Bank, P.O. Box 939, .

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Write only one beneficiary on each line. Make sure that you write the full names of all beneficiaries. For example, if you name you children as beneficiaries, DO NOT merely write “children” on one of the lines; instead write the full names of each of your children on separate lines.

Consider your kids or the person/people taking over guardianship as the primary beneficiary. Your ex-spouse is another option. You could name your parents or siblings as contingent beneficiaries. Most single people with no kids will name their parents or siblings as primary beneficiaries.

If you get married or divorced, or have children or other life changes, standard sequence will follow those life changes. If you never file a beneficiary designation, your benefit will be paid ing to standard sequence at the time of your death.

Health Savings Account (HSA) owners can choose to name their spouse, adult children, other individuals, or a trust as their beneficiary. If no beneficiary is named, the HSA will be distributed to the estate.

Provide the following information on the beneficiary designation: The full name of the trust as it shows on the trust document. The date the trust was created. The name of the trustee, followed by the word “trustee,” or if you cannot provide a trustee, ETF may accept another contact person. The trustee's address.

Beneficiary designations can generally be made via the Member Website. However, if you are married, domiciled in a community property state, and designate a non-spouse primary beneficiary, you must submit a beneficiary form with the notarized consent of your spouse.

spouse, partner, children, parents, brothers and sisters, business partner, key employee, trust and charitable organization.

The total for all primary beneficiaries must equal 100%. If no percentages are specified, the proceeds will be split evenly among those named. If no named beneficiary survives you, settlement will be made to your estate, unless otherwise provided in the Group Contract.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232