Get Health Savings Account Application And ... - Medsave .com

This guide will provide you with clear and step-by-step instructions for completing the Health Savings Account Application and Eligibility Form. By following these guidelines, you will ensure that your application is filled out correctly and submitted efficiently.

Follow the steps to complete your application effectively.

1. Press the ‘Get Form’ button to obtain the application form and open it in your chosen editor.
2. Begin by filling out the personal information section. Enter your Social Security number, birth date, first name, middle initial, last name, street address, city, county, state, zip code, and preferred mailing method.
3. In the initial deposit section, indicate the type of initial deposit you are making. Select from options like Account Holder Deposit, Rollover, Employer Deposit, or Trustee to Trustee Transfer, and fill in the corresponding amount.
4. Complete the employer information section if applicable. Provide the employer's name, contact person, mailing address, and type of business.
5. Certify your account holder eligibility by confirming you are covered by a Qualified High Deductible Health Plan and are not covered by any other health plan providing similar benefits.
6. If you would like to order checks or a debit card, indicate your preferences in the HSA account options section.
7. Read and agree to the rules and conditions applicable to the HSA. Ensure you understand the responsibilities relating to eligibility and contributions.
8. Sign the application where indicated and include the date. If applicable, have an authorized signer or power of attorney sign as well.
9. Review your completed application for accuracy, then save your changes, and download, print, or share the form as needed.

Complete your application online today to take advantage of the benefits offered by your Health Savings Account.