Get Optumhealth Bank Enrollment Form - Sscc

This guide provides clear and detailed instructions for users on how to fill out the OPTUMHealth Bank Enrollment Form - Sscc online. Following these steps will help ensure your application is completed accurately and efficiently.

Follow the steps to complete the enrollment form with ease.

1. Click ‘Get Form’ button to access the OPTUMHealth Bank Enrollment Form - Sscc and open it for editing.
2. Complete Part 1: Personal information - Provide your Social Security number or Tax Identification number, date of birth, first name, middle initial, last name, street address (a PO Box is not acceptable), apartment number, city, state, ZIP code, mailing address if different, work phone number, home phone number, and a verification code for security.
3. If requesting an additional debit card in Part 2, fill in the authorized user's first name, middle initial, last name, date of birth, and Social Security number or Tax Identification number.
4. In Part 3, fill out your high deductible health plan (HDHP) details including the medical insurance company or carrier, medical insurance plan or group number, HDHP member identification number, and select who is covered: individual or family. Additionally, enter the HDHP effective date and indicate if you are enrolling in an HSA through your employer.
5. Complete the identification section under the USA PATRIOT Act by checking the form of identification you are using and providing the necessary information.
6. Should you wish to designate a beneficiary in Part 4, consider filling out the Designation of Beneficiary form if applicable.
7. In Part 5, read through the required acknowledgment and signature section carefully before signing and dating the form.
8. In Part 6, if applicable, indicate whether you are enclosing an opening deposit and specify the amount.
9. Once all sections are completed, save changes, and prepare to download, print, or share the completed form as necessary.

Complete your OPTUMHealth Bank Enrollment Form - Sscc online today to avoid processing delays and fees.