Account Set-up and Maintenance Forms for Health Savings Accounts:
- Beneficiary Change Form
Add or change beneficiary information on your Health Savings Account.
Contribution Forms for Health Savings Accounts:
- Health Savings Account Deposit Form (PDF)
Make contributions by check.
- Health Savings Account Request for Transfer Form (PDF)
Transfer your existing HSA with another financial institution to First American Bank.
- Health Savings Account Review Form (PDF)
Transfer funds from an existing HSA. (Restrictions may apply)
- Eligible Medical Expenses
Example list of qualified medical expenses.
- Health Savings Account Tax Form Correction Request (PDF)
Request changes to your tax forms 1099-SA, 5498-SA, and/or if you have recognized an error to a prior year contribution.
- Sample HSA Payroll Deduction Authorization Form