For your convenience, HSA Manager forms are available below. To access the documents, simply click on the links to the right.

If you need additional assistance, please contact our Health Savings Account Client Service Team at 800.783.4022.

Need to establish an Account?

HSA Manager Kit	HSA Kit
Pershing HSA Manager Kit	PER Kit

Need to update an already established Account?

Add additional authorized signer for debit card	HSA-012
Address Change	HSA-013
Contributions by ACH	HSA-017
Give Third Party Authorization to your Account	HSA-008
Update Beneficiary designation	HSA-016
Funding Form	HSA-018

Need to make a Distribution or submit a Transfer to your HSA Account?

HSA Distribution Form	HSA-014
Transfer from another HSAs, MSAs, or IRA	HSA-007
Transfer from FSAs or HRAs	HSA-019

Statements and Agreements