HSA forms
These are downloadable forms and documents relating to your Everence Federal Credit Union health savings account (HSA).
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HSA forms and documents
Use the tabs below to find forms and documentation related to your Everence HSA.
Select the appropriate tab below
- New accounts
- Existing accounts
- Employers
Distribution/Transfer/Excess Contribution Form
Contribution Form (Year Designation Required)
Open a Health Savings Account
Contact our National Branch for assistance with HSA requests.
Everence Federal Credit Union
Attn: HSA department
2160 Lincoln Highway E., Suite 20
Lancaster, PA 17602
Toll-Free: 800-451-5719
Phone: 717-735-8330
Fax: 717-735-8331
Text: 717-735-8332
Email: [email protected]
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Find an Everence Federal Credit Union branch, shared branch, or fee-free ATM near you.
Disclosure
1 When applying for an HSA debit card, please read the HSA debit card disclosure.