HSA Service Center


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Open an HSA

General Information

Opening an HSA has never been easier. Our step-by-step questionnaire guides you through the entire opening process—including how to print your forms and where to send them when you are done.

To open this HSA properly, we need to gather some specific information about you.

First, please complete the following information about the HSA owner.

Note: All fields marked with an * are required.

Salutation
* First Name	MI	* Last Name
* Address

* City	* State
* Zip Code
* Social Security Number		* Date of Birth	(mm/dd/yyyy)
* Phone
Email Address
HSA Account Identification

* Marital Status Single Married

*What would you like to do?

Make a contribution to an HSA for tax year

Use a qualified HSA funding distribution from a Traditional IRA or a Roth IRA.

Transfer assets to an HSA.

Roll over assets to an HSA.