Manual Claim (Distribution) Form for Eligible Expenses
Use when you require reimbursement for an eligible expense paid out of pocket. Remember to save all receipts to document the HSA eligible expense.
Distribution Form (Read Description Below Carefully)
For use when an employee requires a distribution from their HSA other than a normal distribution. This form is used for requesting various types of distributions such as excess contributions, prohibited transactions, transfers to spouse, death, disability or revocation.
ACH Contributions
For use when an employee needs to setup ACH Authorizations for funding from an existing bank account into their HSA. These contributions are above and beyond anything funded by the employer. The employee is responsible for coordinating with your employer in making sure the account is not over funded and within the current year's contribution limits as provided by the IRS.
Request for Transfer to a Health Savings Account Form
For use when you have an employee that has an HSA with another financial institution. This form can be used for employees to transfer funds from another financial institution to the First Horizon HSA.
Rollover Review Form
For use when an employee has a rollover contribution. The employee should include this form with the rollover funds to be properly coded for tax purposes.
Designation or Change of Beneficiary Form
For use when an employee needs to designate or change beneficiaries.
Add or Remove Authorized Signers Form
For use when an employee needs to Add or Remove Authorized Signers on the HSA Account.
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2008 Contribution Limits
Searching to find the 2008 HSA Contribution Limits?