Account Opening Forms

  HSA Application
  HSA Custodial and Deposit Agreement
  Privacy Policy

Account Servicing Forms

  Contribution/Deposit Form
  Designation of Beneficiary Form
  Additional Debit Card Request
  Name Change Notification Form
  Withdrawal/Distribution Form
  Rollover/Transfer Request Form
  Customer Request Account Closure
  Debit Card Dispute Form
  Information Authorization Form
  Withdrawal Correction Form
  Transfer of Funds – ACH Deposit
  Transfer of Funds – ACH Withdrawal
  Statement Delivery Change Request
  IRA Rollover/Transfer Request Form
  Fillable Expense Tracking Worksheet

Employer Servicing Forms

  Employer Contribution Form


Informational Materials

  HSA Consumer Guide
  OptumHealth Bank Account Options
  Eligible/Ineligible Expenses
  Health eAccess Fee Schedule
  Health eInvestor Fee Schedule
  Health eSaver Fee Schedule

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