Get Hsa Rollover/transfer Request Form - Healthequity

This guide provides users with step-by-step instructions on how to complete the HSA Rollover/Transfer Request Form - HealthEquity online. It aims to assist individuals in accurately filling out the necessary information to facilitate the transfer or rollover of funds into their HealthEquity Health Savings Account (HSA).

Follow the steps to accurately complete the HSA Rollover/Transfer Request Form online.

1. Press the ‘Get Form’ button to access the HSA Rollover/Transfer Request Form and open it in your chosen document editor.
2. Begin with Part I, which involves entering the primary account holder information. Fill in your last name, first name, middle initial, street address, city, state, ZIP code, and email address. Additionally, provide your daytime phone contact and Social Security Number or HealthEquity ID number, which is required.
3. Indicate your health insurance company's name and the effective date of coverage. Specify the coverage type, choosing between 'Single' or 'Family.' Then select one of the three options regarding your current HealthEquity HSA status.
4. Proceed to Part II if you are completing a transfer. Provide the name of the financial institution or employer, along with their daytime phone number and address. Enter the current HSA/IRA/MSA account number and the dollar amount you wish to transfer, if known.
5. Specify whether this transfer will or will not close your existing account. Indicate the account type from which the funds will come, selecting the appropriate checkbox.
6. Complete the current custodian information and check the option to make a check payable to HealthEquity if required. Make sure to include a notary seal if requested by your current custodian.
7. In Part III, if you are completing a rollover, specify the rollover amount and choose between the different options for submitting funds. Provide the necessary details related to your checking or savings account if using electronic funds transfer.
8. Review all entries for accuracy before finalizing. When finished, save your changes, and choose whether to download, print, or share the completed form.

Complete your HSA Rollover/Transfer Request Form online today to ensure a smooth transfer or rollover process.