Get Wex Health Savings Account (hsa) Transfer Request Form 2022-2025

Filling out the WEX Health Savings Account (HSA) Transfer Request Form online is essential for transferring your HSA funds directly to WEX Health, Inc. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the transfer request form

1. Press the ‘Get Form’ button to access the WEX Health Savings Account (HSA) Transfer Request Form and open it in your editing tool.
2. Begin with the Account Information section. Fill in your employer's name without abbreviations, your full name (first, middle initial, and last), your Social Security number, and your contact details including your telephone number and address (city, state, and zip code). Pay special attention to the required fields marked with an asterisk (*).
3. Move to the Existing HSA/IRA Trustee or Custodian Information section. Provide the name of the current Trustee or Custodian of your HSA/IRA, along with the existing account number. Additionally, fill in the custodian's address and their telephone number.
4. If applicable, complete the Former Spouse Information section in full if the transfer includes assets from a former spouse as part of a divorce settlement. Include their HSA account name, address, Social Security number, date of birth, and telephone number, and attach a copy of the divorce decree.
5. In the Transfer Instructions section, indicate whether you want to transfer all or part of your HSA or IRA. If you are making a partial transfer, specify the amount. Ensure to provide the name of the beneficiary receiving the funds and indicate whether the transfer will close the existing HSA/IRA or not.
6. Proceed to the Asset Liquidation Instructions section. Indicate your preferences for asset liquidation. By default, select the option to liquidate all assets immediately unless stated otherwise. Note any specific instructions regarding assets that are to be liquidated or retained.
7. Finally, review the Transfer Signature of HSA Accountholder or Former Spouse section. Sign and date the document, confirming the accuracy of the information provided and acknowledging potential tax implications. Ensure that all required signatures are obtained.
8. Once all sections are accurately completed, save the changes to your document. You can then download, print, or share the form as needed for submission.

Complete your WEX Health Savings Account (HSA) Transfer Request Form online today for a seamless transfer process.