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  • Account Closing Form - Avidia Health

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HSA Account Closing FormInstructions: Use this form to remove all funds from your Health Savings Account (HSA) and close your account with Avidia Bank. Complete this form and email or mail to: HSADeposits.

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Instructions: Use this form to remove all funds from your Health Savings Account (HSA) and close your account with Avidia Bank. Complete this form and email or mail to: HSA@avidiahealthcaresolutions.com or Avidia Bank, P.O. Box 161390 Altamonte Springs, FL 32716.

The IRS allows each HSA account holder to “roll over” their funds to a new HSA provider every 12 months and maintain the tax-advantaged status of the HSA. If you request a “rollover,” the HSA custodian will send the funds to you via check or transfer to your personal bank account (not your HSA).

In those cases, please call us at 800-508-2265.

If additional assistance is needed, please contact us at 855.248.6311 or hsainfo@avidiabank.com, and we will send the forms directly to you.

You may make only one rollover contribution to an HSA during a one-year period. You have 60 calendar days from the date you receive these funds to deposit them into another HSA.

Eligible Expenses Avidia members can use their HSA funds for certain medications, medical equipment, and other healthcare-related expenses.

The IRS allows you to roll over your HSA funds every 12 months and still maintain the tax-free status. After you request a rollover, your current HSA provider will either send you the money via bank transfer or by mailing a check.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232