Get To Avoid Processing Delays, Please Complete All Fields On The Application Starred Fields (*) Are

Filling out your Health Savings Account (HSA) application accurately is essential to avoid any processing delays. This guide provides clear instructions for completing the application online, ensuring all required fields are addressed thoroughly.

Follow the steps to effectively complete your HSA application.

1. Press the ‘Get Form’ button to access the application and open it in the editor.
2. Begin with Part 1, Personal Information. Fill out all starred fields (*), including your social security number or tax identification number, date of birth, first name, last name, and address information. Ensure you only use your physical address and avoid PO boxes.
3. If applicable, provide your mailing address if it differs from your street address. Complete the home and work phone fields, as well as the verification code for security purposes.
4. In Part 2, if you wish to request an additional HSA debit card for an authorized user, provide their first name, middle initial, and last name.
5. Move to Part 3, where you will need to provide information about your high deductible health plan (HDHP). Fill in the starred fields, including the medical insurance company name, plan or group number, and the HDHP effective date. Indicate whether you are enrolling in the HSA through your employer.
6. In Part 4, you have the option to provide beneficiary information. This step is not mandatory but is essential for determining where funds will go in the event of your passing.
7. Part 5 requires your signature. Read through the certification statements, affirming your understanding and agreement before signing and dating the application.
8. Finally, you can make an opening deposit once your application is approved. You will receive a notification regarding your application status and can log into your account for further actions.

Complete your HSA application online today to ensure a smooth processing experience.