8772480510 8557176571 PO Box 6161 Fargo, ND 581086161 mercermarketplaceaccounts serviceaccount.com Health Savings Account (HSA) Distribution Request/Account Closure Form Use this form to request a.
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How to fill out the Mercermarketplaceaccounts Serviceaccount Com online
Completing the Mercermarketplaceaccounts Serviceaccount Com form is essential for managing HSA distributions and account closures. This guide provides clear instructions for each section of the form to ensure accurate completion.
Follow the steps to fill out the HSA distribution request/account closure form
- Click the ‘Get Form’ button to obtain the form and open it for editing.
- In the first section, provide the account holder information. Fill in the employer name, participant's name (first, middle initial, last), social security number, physical address (note that a PO Box is not acceptable), city, day telephone number, state, zip code, and date of birth in the format MM/DD/YYYY.
- If you intend to close your HSA, proceed to Step 2 and select one of the options provided. Indicate whether you want to close the HSA and issue a final normal distribution for the total balance or close the HSA due to mistaken enrollment or ineligibility, ensuring the account has a $0 balance.
- In Step 3, select the distribution type. Specify the requested amount and choose one of the following distribution options: normal, excess contribution removal (including the date of excess contribution), rollover, transfer (including new custodian’s name and address), disability, divorce, prohibited transaction, or mistaken contribution.
- For Step 4, provide the authorized signatures. Certify that you are the proper party to receive payments from this HSA, that all provided information is true and accurate, and acknowledge that you have read and understood the applicable rules and conditions. Include the account holder's signature and date.
- Once all information is accurately filled out, review the form for completeness. You can then save the changes, download it, print it, or share it as needed.
Complete your HSA distribution request or account closure form online today!
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How do I contact Mercer Marketplace HSA?
Visit .mercermarketplace.com/login or call one of our Mercer Marketplace 365 benefits counselors at 1-855-9MERCER (1-855-963-7237).
What can I use my Mercer Marketplace card for?
The Mercer Marketplace HSA is a tax-exempt plan that works in conjunction with a medical High Deductible Health Plan (HDHP) and allows you to pay for out-of-pocket eligible expenses with tax-free dollars. This includes deductibles, coinsurance, copayments, prescription drugs and more.
How do you contact Mercer?
CALL US. 1-888-434-1144. For the deaf or hard of hearing, please dial 711 for Telecommunications Relay. FAX. 1-857-362-2999. Use our secure fax to send information to us. MAIL. Send by mail to the following address: Mercer Marketplace. PO Box 14401.
What is Mercer Marketplace 365 debit card?
The Mercer Marketplace debit card is the fastest and most convenient way to pay for eligible expenses. The debit card makes it easy to access funds in your pre-tax benefits accounts, reducing your out-of-pocket costs.
Who is Mercer Marketplace 365?
Mercer Marketplace 365 is a flexible health & benefits solution that improves the cost and quality of care for both employers and employees.
How do I check the balance on my Mercer marketplace card?
If your card was declined, please check the available balance in your account by accessing the Mercer Marketplace 365 participant portal at .yourflexbenefits.mercermarketplace365.com or mobile app “Your Flex Benefits”. You can also contact Mercer Marketplace 365 Participant Services at (866) 268-0142.
What is Mercer HSA service fee?
Health Savings Account (HSA) If you choose to keep your funds with Mercer/TRI-AD, your account will be converted to a Retail HSA Account with UMB by April 1, 2022, and you will be charged a $2.75 monthly service fee.
How do I contact Mercer Marketplace 365?
If you are an active employee and have questions regarding your employer health benefits offered through Mercer Marketplace 365, please call 1 855 963 7237; alternatively, if you are a retiree of an employer offering health benefits through Mercer Marketplace 365 and are interested in enrolling in coverage or have ...
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