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  • Health Savings Account Death Beneficiary Change Form

Get Health Savings Account Death Beneficiary Change Form

S Step 1 of 5: Account Holder Information *HSA Account Holder Name (First, MI, Last) - *Social Security Number *Employer Name (Do not abbreviate) *Employee ID Step 2 of 5: Designation of Death Beneficiary(ies) New Death Beneficiary(ies) - The following individual(s) or entity shall be my primary and/or contingent death beneficiary(ies). If neither primary nor contingent is indicated, the individual or entity will be deemed to be a primary death beneficiary. Replace Death Beneficiary(ies) -.

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To add an authorized signer, follow these easy steps. After logging into your account, click on the Profile tab. Next, click on Add Authorized Signer. You will then be asked to provide information about your chosen authorized signer, including his/her Social Security Number and his/her birthdate.

To designate a beneficiary or change current beneficiaries, complete the Designation of Beneficiary Form. This form allows you to indicate if the individual is an initial, replacement or additional beneficiary. This form can be accessed at: .hsabank.com/beneficiary.

The funds in your HSA go to the named beneficiary of the account when you die. If there is no beneficiary designated, the funds could go to your estate. If you're married, your HSA money may automatically go to your spouse, depending on the laws in your state or the policy of your HSA company.

To request a name change, please attach a copy of Marriage License, Divorce Decree, W2 or Social Security Card. To correct the DOB we have on file which we use for account authentication purposes, please attach a copy of Driver's License or State Issued ID card, Passport or Birth Certificate.

It's the person or legal entity who will receive your HSA funds when you pass away. Designating a beneficiary is important to ensure that the funds in your HSA will easily transfer to your loved ones when you're gone. You can choose one beneficiary or, choose multiple and assign percentages to each.

The funds in your HSA go to the named beneficiary of the account when you die. If there is no beneficiary designated, the funds could go to your estate. If you're married, your HSA money may automatically go to your spouse, depending on the laws in your state or the policy of your HSA company.

If the policy has joint ownership, all owners must sign any form submitted. Complete the Request for Change of Beneficiary form by listing the full given name for each person being named. Indicate their address, social security number, date of birth, and relationship to the insured person.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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