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Get Request For A Health Savings Account (HSA) - Blue Cross And Blue ...

Your BlueEdge HSA health plan. While you may open an HSA with any institution of your choice, we have arranged for you to be able to establish your BlueEdge health plan and initiate the process of opening an HSA with Mellon Financial (Mellon)* all in one easy step. Please complete this form to let us know if you intend to open a Mellon Health Savings Account (HSA) by providing the authorization as noted below. BCBSIL will notify Mellon once your BlueEdge health plan is activated to let them know.

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