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  • For Individuals

      Get Started

    • Opening an HSA
    • Transfer Your HSA

      • Learn

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    • Help Center for Individuals
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  • Products

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    • HRA | Health Reimbursement Arrangement

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Account Forms

This is a resource directory to help manage your account. Bookmark this page for access to common forms and documents you need to manage your account.

Health Savings Account

  • Beneficiary Designation Form
  • Electronic Funds Transfer (EFT) Setup Form
  • How To Transfer Your HSA Guide
  • HSA Eligible Expenses
  • HSA Member Guide
  • HSA Transfer/Rollover Form
  • HSA-Compatible FSA Eligible Expenses
  • The Complete HSA Handbook

Flexible Spending Account

  • Dependent Care FSA Eligible Expenses
  • Healthcare FSA Eligible Expenses

Dependent Care

  • Dependent Care Claim Form

Health Reimbursement Arrangement

  • HRA Eligible Expenses

Healthcare

  • Capital Expense Worksheet
  • Card Use Verification Checklist
  • Healthcare - Pay Me Back Claim Form
  • HIPAA Authorization Form
  • HIPAA Authorization Revocation Form
  • Letter of Medical Necessity

Commuter

  • Commuter Eligible Expenses
  • Commuter - Pay Me Back Claim Form

Documents

  • Custodial Agreement
  • Investment Guide
  • IRS Publication 502
  • Request For Treatment As An Assistance Eligible Individual

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