Resources.healthequity.com

HSA MEMBER GUIDE

WEB1. Log into the member portal. 2. Select ‘Investments’ from the ‘My Account’ tab. 3. Select which investment level suits your investment goals. A.‘Advisor Auto-Pilot’ and ‘Advisor …

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URL: https://resources.healthequity.com/Documents/HSA_Member_Guide_Amex.pdf

Health Savings Account (HSA) Individual Enrollment Form

WEBHealth Savings Account (HSA) Individual Enrollment Form . Mail or fax completed forms to: Address: HealthEquity, Attn: HSA Enrollment. PO Box 14374, Lexington, KY 40512 . …

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Health Savings Account (HSA)

WEBHealth Savings Account (HSA) Schedule of Fees . The following fees apply to your HSA. Your employer, health plan, or insurance company may have arranged to pay the …

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Primary Account Holder Information

WEBHSA Reimbursement Form . Mail or fax completed forms to: Address: HealthEquity, Attn: Member Services. Fax: PO Box 14374, Lexington, KY 40512 801.727.1005

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Account holder information Appeal information Explanation …

WEB1. HealthEquity must receive your appeal within 180 days of the date your denial notice was sent. 2. Decisions on appeals will be sent within 30 days of HealthEquity receiving the …

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Employer Portal Guide

WEBIf you are associated with one of HealthEquity’s integrated health plan or third-party administrator (TPA) partners, they are sending enrollment data to …

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HSA Change of Personal Information Form

WEBHSA Change of Personal Information Form. HSA Change of Personal Information Form. Mail or fax completed forms to: Address: HealthEquity, Attn: Member Services. PO Box …

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Important HSA Tax Information

WEBContribution limits for 2010 are $3,050 for individuals and $6,150 for families. If you’re 55 or older, you can make an added $1,000 “catch up” contribution. Make contributions on …

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Claim Filing Requirements

WEB• Name of provider • Name of patient • Description of services • Date (s) of service. The paid date may or may not be the same as the date of service; the date of service is required.

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HSA Contribution Form

WEBHSA Contribution Form . Mail or fax completed forms to: Address: HealthEquity, Attn: Member Services. PO Box 14374, Lexington, KY 40512. Fax: 801.727.1005

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HSA partial transfer out request form

WEBTo authorize HealthEquity to transfer a partial amount of your health savings account (HSA), complete this form. You must leave at least $25.00 in . your cash balance in …

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Transfer request form

WEB(health savings account) Current custodian instructions. Make check payable to HealthEquity and mail it to: HealthEquity, Attn: Operations, PO Box 14374, Lexington, …

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HSA Closure request form

WEBTo authorize HealthEquity to close your health savings account (HSA), complete this form. A closure fee of up to $25.00 may apply. Please contact . HealthEquity at 866.346.5800 …

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Beneficiary Designation Form

WEBPlease mail or fax completed forms to: Address: HealthEquity, Attn: Member Services . PO Box 14374 Lexington, KY 40512

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Distribution of Excess HSA Contribution Form

WEBHSA contribution limits applicable for each tax year. Please contact HealthEquity Member Services at 866.346.5800 for assistance.

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Claim filing requirements

WEB1. Name of provider 2. Name of dependent receiving care 3. Type of care 4. Date(s) of care. The paid date may or may not be the same as the date of care; the date of care is required.

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HEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENT

WEBHEALTH SAVINGS ACCOUNT CUSTODIAL AGREEMENT. would exceed the available funds in the Account. If the Account becomes overdrawn for any reason, the Member …

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Return of Mistaken HSA Contribution Form

WEBReturn of Mistaken HSA Contribution Form . Mail or fax completed forms to: Address: HealthEquity, Attn: Client Services. PO Box 14374, Lexington, KY 40512

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HIPAA authorization form

WEBhealth care to me. In accordance with the provisions of the Health Insurance Portability and Accountability Act (HIPAA), I, the undersigned, grant permission to HealthEquity, Inc. to …

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Health savings account (HSA) instructions upon death of

WEBUpon the death of a HealthEquity account holder, use this form to provide direction regarding the decedent’s HSA. Note: Before processing this request, HealthEquity will …

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