Get Hsa Distribution Request Form - Healthscope Benefits

Filling out the HSA Distribution Request Form is essential for accessing funds from your Health Savings Account (HSA). This guide provides clear instructions for users to complete the form online effectively and confidently.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Provide your accountholder information by filling in your last name, first name, middle initial, social security number, and employee ID, along with the name of your employer if applicable.
3. Choose the reason for the distribution from the options provided. You may select only one reason per form, such as Normal, Disability, or Prohibited Transaction Distribution.
4. Enter the amount of distribution under the designated field. If applicable, provide details for excess contribution removal, including the amount and the date the excess contribution occurred.
5. If you are requesting a rollover or transfer, indicate whether you wish to close your HSA account and provide the necessary information regarding the receiving administrator or custodian.
6. Sign the form certifying that you are the HSA accountholder or an authorized individual. Ensure you review that all information provided is accurate.
7. After completing the form, save any changes made. You may also choose to download a copy for your records, print it out, or share it as needed.

Complete your HSA Distribution Request Form online today for a seamless experience.