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.
Identify who should receive your HSA assets in the event of your death.
Move money to Associated Bank from another HSA custodian or trustee within your 60 day rollover window.
Directly transfer all or part of your HSA from another trustee or custodian to Associated Bank.
Designate your spouse or a competent third party to withdraw funds from the account. Along with the Limited Power of Attorney Authorization, the HSA Supplemental form should be completed by the LPOA. Be sure to print and return both forms together.
Make a deposit to return money that was disbursed inappropriately, or to make a contribution other than pre-tax direct deposit.
Examples of qualified medical expenses.
Send this form to Associated Bank via secure email to email@example.com, 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.
Present this HSA form to the bank to make any withdrawal for reasons involving excess contribution or disability.
These forms require Adobe Acrobat Reader.