Get Health Savings Account (hsa) Application - Optum Bank

Filling out your Health Savings Account (HSA) Application with Optum Bank online is a straightforward process that ensures your application is processed efficiently. This guide provides clear, step-by-step instructions to help you complete all necessary fields accurately.

Follow the steps to successfully complete your HSA application.

1. Click ‘Get Form’ button to access the application form online and open it.
2. Begin with Part 1: Personal Information. Fill in your Social Security Number or Tax Identification Number, Date of Birth, First Name, Middle Initial, Last Name, Street Address (note that a PO Box cannot be used), Apt Number (if applicable), City, State, ZIP Code, Home Phone, and Verification Code for security (up to 10 letters). If your mailing address differs from your street address, complete those fields as well.
3. Move to Part 2: Request for additional debit card (optional). If you wish to add an authorized user, complete their First Name, Middle Initial, Date of Birth, Last Name, and Social Security Number or Tax Identification Number.
4. In Part 3: High deductible health plan (HDHP)/medical plan information, enter your Medical Insurance Plan or Group Number, Medical Insurance Company or Carrier, HDHP Member Identification Number, and select who is covered by checking the appropriate option (Individual or Family). Provide the HDHP Effective Date and indicate if you are enrolling through your Employer, including the Employer’s name if applicable.
5. For identification purposes as mandated by the USA PATRIOT ACT, select your form of identification from the options provided (Driver’s License, State ID, or Passport) and fill in the required details.
6. If desired, move to Part 4: Beneficiary information. You can designate a beneficiary for your HSA by completing the Designation of Beneficiary form, which is available on myuhc.com or through customer service.
7. Complete Part 5: Required signature by reading carefully through the statements provided. Your signature and date are needed for processing.
8. In Part 6: Opening deposit, indicate whether you are enclosing an opening deposit with your application. If yes, specify the amount and ensure you write your name and Social Security Number on the check.
9. After reviewing your completed application for accuracy, you can save changes, download the application, print it, or share it as necessary.

Complete your HSA application online today to avoid additional processing fees.