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
> 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
> FlexHSA® Authorization for Automatic ACH Debits
> FlexHSA® Account Level Transfer
> Bank Disclosure
> 2007 Instruction for IRS Form 8889
> 2007 IRS Form 8889