HSA Downloads

Please read the entire application and disclosure package.  It contains important information about the terms of your Health Savings Account.

When you click on the link, the PDF will open in a new tab in your browser so you can continue to read the instructions below.

Download the Application and Disclosure Packet


  1. Print the first 6 pages and fill out all of the information.
  2. Scan the completed 6 pages, along with a clear scan of your selected form of ID.
  3. Email your completed application scans back to your company representative.
  4. Keep a copy of your completed scans and download/print the remainder of the PDF for future reference.