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Health savings account forms

These are downloadable forms and documents relating to your Everence Federal Credit Union health savings account.

HSA forms for account owners
  Everence Federal Credit Union Membership and Health Savings Account Application
  Everence Federal Credit Union HSA Disclosure Statement
  Everence Federal Credit Union HSA Custodial Agreement
  HSA Eligibility Worksheet
  Everence Federal Credit Union HSA Debit Card Application
  HSA Limited Power of Attorney form
  HSA Contribution Form
  HSA Distribution Request Form
  HSA Beneficiary Change Form
  Direct Transfer or Rollover of MSA or HSA Funds
  Transfer of IRA funds to an Everence Federal Credit Union HSA
  HSA Investment Option Agreement
  HSA Investment Choice Form
  HSA Investment Choice Change Form
  HSA Investment Liquidation Request Form
  Request for Return of HSA Excess Contributions
  Request to Close Health Savings Account
  Eligible Expenses for HSA
 

HSA forms for employers

 
  Everence Federal Credit Union HSAs – A Summary for Employers
  Everence Federal Credit Union HSA Group Contributions
disclaimer

Everence offers credit union services that are federally insured by NCUA. Investments and other products are not NCUA or otherwise federally insured, may involve loss of principal and have no credit union guarantee. All products are not available in all states.

© 2013 Everence