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  • Cardholder Dispute Form - Healthequity

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Cardholder Dispute Form Disputing a Transaction Complete this form if you wish to dispute a charge to your HealthEquity HSA Debit Card. This dispute must be received in writing, filled out completely,.

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The HealthEquity card helps you stay in compliance with IRS rules and can be used at health-related merchants and vendors to pay for your eligible health expenses. Even if you accidentally try to use your HSA card for a tank of gas, or movie tickets, your HealthEquity debit card won't let you make that mistake.

Once HSA Bank is properly notified of an unauthorized transaction, you'll be credited promptly while we investigate the unauthorized transaction dispute. Final credit to the HSA is subject to verification.

Using your card Cards must be run as 'credit' (card may be declined if run as debit) and no personal identification number (PIN) is required. Once activated, use it like a regular credit card to pay for your plan-allowed medical expenses (for HSA and FSA plans, see our article on qualified medical expenses).

Use the HealthEquity member portal or mobile app to submit a reimbursement for the accumulated qualified medical expenses and receive a tax-free payment for the amount of out-of-pocket expenses you paid.

Please contact Member Services at 866-346-5800 to dispute charges or report your card lost or stolen. We are available every hour of every day to assist you.

Reimbursements are typically processed with seven business days. If your insurance provider automatically sends your claims to HealthEquity, please allow up to 30 days for receipt of the claim.

A transaction dispute is a consumer complaint related to a credit or debit card purchase. Transactions are most commonly disputed because of fraud (unauthorized purchases) and a lack of merchant follow-through (merchandise not as expected, services not performed, credit not issued, etc.).

You have the right to appeal any FSAFEDS denial that involves your Health Care FSA, Limited Expense Health Care FSA, or Dependent Care FSA. Common reasons for appealing a claim include: A claim or request for reimbursement was not paid in full. A product or service that you believe is an eligible expense was denied.

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© Copyright 1997-2025
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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
DMCA Policy
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:
1-877-389-0141
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