This page gives you immediate access to Small Group Health Insurance Forms and Applications for California.
HSA Bank - Forms & Applications For Small Groups - California
 
If more than one result is on this page, hit 'Alt + s' (just hold the Alt button and hit the s key) on your keyboard to find the next matching result
Select a Category...    Group Medical
Company
Group Medical - HSA - EMPLOYEE
Description Form # Rev Date Fillable
HSA Bank
 Employee Application This is the form to fill out to enroll in our HSA. app hsaae 5-29-08 Yes
HSA Bank
 Account Information Change Form You can use this form to update your account if you've experienced multiple changes, such as: name change, address change, changed beneficiaries, or want to add/change your Authorized Signer.   2-08 Yes
HSA Bank
 Authorized Signer This form allows you to designate an Authorized Signer for your HSA.   2-08 Yes
HSA Bank
 Automatic Contribution Form Allows you to make contributions directly from your personal checking or savings account.     Yes
HSA Bank
 Contribution Form Use this form to make a contribution to your account.     Yes
HSA Bank
 Designation of Beneficiaries If you wish to designate beneficiaries to your HSA, please complete this form.   12-07 Yes
Company
Group Medical - HSA - EMPLOYER
Description Form # Rev Date Fillable
HSA Bank
 Employer Form -    English  |  Spanish For employers that would like to access HSA Bank's Employer Administration Area to manage its employee list, download resources, and make contributions online. ERSignup 3-08 Yes
HSA Bank
 Employer Guide Comprehensive guide for employers, detailing enrollment, contributions, and disbursement options.      
HSA Bank

Group Online Contribution Form

Group Online Contribution Instructions

For employers that would like to make contributions to employee HSA's online. The ACH Origination Agreement (included in the Group Online Contribution Form PDF) must be submitted with the Group Online Contribution Form.

 GOCSignup ACH 3-08 Yes
HSA Bank
 Employer Contribution Form - excel file For employers to use when making contributions for employees (including individual, employee pre-tax, and employer contributions).      
HSA Bank
 Employee Add/Remove Form For employers to add or remove an employee.   3-08 Yes
HSA Bank
 ACH Process Instructions How to use an Automated Clearing House to contribute funds to employee accounts.