Get Cardholder Dispute Form - Healthequity

Filing a Cardholder Dispute Form is an essential step for users seeking to contest a charge on their HealthEquity HSA Debit Card. This comprehensive guide will walk you through the process of completing the form online, ensuring that you provide all necessary information to effectively process your dispute.

Follow the steps to successfully complete your dispute form.

1. Press the ‘Get Form’ button to access the Cardholder Dispute Form and open it in your online editor.
2. Provide your account holder information in the designated fields: include your full name, street address, city, state, zip code, phone number, Health Savings Account number or Social Security number, and HSA debit card number.
3. Specify the reason for disputing the transaction by selecting the appropriate option. Options include not recognizing the transaction amount or merchant, being charged twice for the same transaction, or having an unposted credit slip.
4. Indicate the status of your HealthEquity HSA Debit Card by selecting from the available options, such as whether it was never received, lost, in your possession at the time of the transaction, or stolen.
5. In the provided box, describe the circumstances surrounding the lost or stolen card, if applicable.
6. Explain how you became aware of the unauthorized activity and specify any details that are relevant to your dispute.
7. Detail your attempts to resolve the disputed transaction with the merchant, as required prior to completing your dispute with HealthEquity.
8. Fill out the last transaction date, time, and amount if applicable, or indicate if you have not yet used your HSA Debit Card.
9. List the transaction details that you are disputing, ensuring you indicate that you did not benefit from them, was unauthorized, or was made by another.
10. Review your responses carefully, and ensure that all information is accurate before finalizing your form.
11. Complete the signature section, and add the date to certify the accuracy of the information provided.
12. Submit your form by faxing or mailing it to the appropriate HealthEquity address, as indicated in the form instructions.

Start completing the Cardholder Dispute Form online to resolve your transaction issues.