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  • Payflex Hsa Trustee Transfer Form

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Health Savings Account (HSA) Transfer Form Instructions (Transferring funds from your Current HSA to your New PayFlex HSA) As the owner of your HSA, you are required to complete Sections 1, 2, and.

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Related content

(HSA) Transfer Request Form Instructions
Transfer to HSA at PayFlex Request Form. Instructions: Complete sections 1, 2 and 3 on...
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PF-16 - Health Savings Account (HSA) Transfer...
(Transferring funds from your Current HSA to your HSA at PayFlex®) ... Please Mail this...
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Click on the Financial Center. Note: If you have multiple accounts, select your Health Savings Account from the drop-down menu at the top of the page. Click on Make an HSA Withdrawal. This lets you withdraw funds from your HSA and deposit them into your linked bank account.

Click on the Financial Center. Note: If you have multiple accounts, select your Health Savings Account from the drop-down menu at the top of the page. Click on Make an HSA Withdrawal. This lets you withdraw funds from your HSA and deposit them into your linked bank account.

The IRA and HSA in question must be owned by the same individual (funds are non-transferable to a spouse or partner). Funds can be transferred from a Traditional or Roth IRA without further restrictions. Funds can be transferred from an SEP or Simple IRA as long as the IRA is no longer considered “ongoing” by the IRS.

Outgoing Trustee to Trustee Fee $25.00 This fee is deducted from your HSA when you request to transfer your HSA funds to another HSA custodian. If you close your HSA with PayFlex, we won't charge a fee to transfer your HSA funds.

$2.50 per ATM transaction.

Amount Description If you close your HSA with PayFlex, we won't charge a fee to transfer your HSA funds. Non-Sufficient Funds (NSF) Fee (Overdraft) $25.00 This fee is deducted from your HSA each time an expense is paid to a merchant or provider and you don't have enough money in your HSA.

After reviewing and completing the form, please sign and date the form under the “Certification and Signature” section. Mail this HSA Transfer Form to: HSA Operations, P.O. Box 8606, Omaha, NE 68154. PayFlex will sign and forward this form to your custodian.

Keep your PayFlex account and pay individual administrative fees. Complete a Direct Transfer Request Form using the information from your new account with HSA bank. Fax the form to PayFlex: 402-943-1567. Mail the form to PayFlex at the below address:

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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
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