Account Set-up and Maintenance Forms for Health Savings Accounts:

• Paper Application
  Download our paper application if you do not wish to complete your application online.
• Beneficiary Change Form
  Add or change beneficiary information on your Health Savings Account.

Contribution Forms for Health Savings Accounts:

• Automatic Savings Form
  Make contributions directly from your personal checking or savings account.
• HSA Deposit Form
  Make contributions by check.
• Employer Contribution Form
  For employers to use when making contributions for employees (employee pre-tax and employer contributions).

Transfer/Rollover Forms:

• HSA Request for Transfer Form
  Transfer your existing HSA with another financial institution to First American Bank.
• HSA Rollover Review Form
  Transfer funds from an existing HSA. (Restrictions may apply)

Miscellaneous Forms:

• Eligible Medical Expenses
  Example list of qualified medical expenses.
• HSA Tax Form Correction Request
  Request changes to your tax forms 1099-SA, 5498-SA, and/or if you have recognized an error to a prior year contribution.

Employer Materials:

• Employer Guide
  Comprehensive guide detailing enrollment, contributions and disbursement options.
• Employer Contribution Form
  For employers to use when making contributions for employees (employee pre-tax and employer contributions).
• Employer Presentation
  An informative presentation about First American Bank's Health Savings Account program.