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- Consumer-Driven Health Plans
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- Health Savings Accounts
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- Employee Benefit Administration Tools
Health Savings Accounts Forms
Find helpful forms for managing your Associated Bank Health Savings Accounts here. If you don't see the HSA form you need, call us at 800-992-2651.
HSA Beneficiary Designation
Identify who should receive your HSA assets in the event of your death.
HSA Transfer Request
Directly transfer all or part of your HSA from another trustee or custodian to Associated Bank.
Limited Durable Power Of Attorney Authorization for HSA
Designate your spouse or a competent third party to withdraw funds from the account.
HSA Contribution and Investment Selection
Make a contribution other than pre-tax direct deposit.
Qualified Medical Expenses
Examples of qualified medical expenses.
HSA Qualified Expense Reimbursement Form
Send this form to Associated Bank via secure email to firstname.lastname@example.org, or mail to: Associated Bank, NA Attn: HSA Department MS 7009, PO Box 19097, Green Bay, WI 54307-9097, or fax to 920-405-2324.
HSA Withdrawal Authorization
Present this HSA form to the bank to make any withdrawal for reasons involving excess contribution or disability.
HSA Mistaken Distribution Repayment
Make a deposit to return money that was disbursed inappropriately.
HSA Contribution Eligibility form for Rollover
Move money to Associated Bank from another HSA custodian or trustee within your 60 day rollover window.
These forms require Adobe Acrobat Reader.