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Health Saving Account Forms If you are an employer or an individual
looking to open an HSA Account with Millennium Trust, simply
click on the appropriate link below. All the appropriate forms
you need to fill-out, or retain for your records, will be
presented together in one group. You may start your enrollment
process by completing the enrollment application forms online,
or downloading the forms, filling them out where indicated, and
mailing them to the address indicated on each respective form or
packet of forms.
>
Individual Enrollment Packet
>
Employer Enrollment Packet
If you are an existing client, or you are looking for a
specific form, please click on the individual form(s) listed
below.
> FlexHSA® Individual Enrollment Instructions
> FlexHSA® Employer Enrollment
Instructions
> FlexHSA® Adoption Agreement
> FlexHSA® Custodial Agreement
> FlexHSA® Employer Contribution Form
> FlexHSA® Rollover/Transfer
>
FlexHSA® FSA/HRA Rollover Authorization
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FlexHSA® Delivery Instruction
> FlexHSA® Third Party Authorization
> FlexHSA® Services and Fee Schedule
> FlexHSA® Partial List of IRS Expenses
> FlexHSA® Additional Authorized Signature
> FlexHSA® Address Change Request Form
> FlexHSA® Distribution Request Form
>
FlexHSA® Beneficiary Designation
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FlexHSA® Authorization for Automatic ACH Debits
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FlexHSA® Account Level Transfer
> Bank Disclosure
> 2007 Instruction for IRS Form 8889
> 2007 IRS Form 8889
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