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Health Savings Acount - Banks

HSA Bank
  • Employer Sign-Up form
  • Group Online Contribution Form (If the Employer is contributing to the employee HSA's online)
  • Employer Contribution Form (If the Employer is making contributions for employees - not necessarily online)
Submit the completed enrollment material to:
HSA Bank
P.O. Box 939 Sheboygan, WI. 53082-0939
Phone: (866) 357-5232
The Employer Sign-up form should be faxed to (920) 803-4184
Sterling HSA
Sterling HSA is a strategic partner with Warner Pacific for health savings accounts. The professionals at Sterling are experts in the health benefits industry whose primary focus is putting employers and consumers in control of their health care spending. Sterling can provide administrative functions for any HSA compatible plan for any carrier.
  • Employer Group Application
  • Employer List Bill (if appropriate)
  • Individual Sterling HSA Enrollment Form
  • Beneficiary Designation Form
  • Deposit check made payable to Sterling HSA
Submit the completed enrollment material to:
Sterling HSA
475 14th Street, Suite 120, Oakland, CA. 94612.
Phone: (800) 617-4729
Aetna HealthFund Health Savings Account
  • Aetna HealthFund Health Savings Account (HSA) Enrollment Form
  • Aetna HealthFund Health Savings Account (HSA) Beneficiary Designation Form
  • Aetna HealthFund Health Savings Account (HSA) Electronic Funds Transfer Authorization (EFT) forms
    (if you wish to have your contributions transferred into your HSA directly from your checking account)
  • Please do not submit an HSA contribution at this time. You will receive deposit slips in your HSA Welcome Kit
Submit the completed enrollment material to:
Aetna
Attention: HSA Enrollment
151 Farmington Ave. Hartford, CT. 06156-8961
Phone: (877) 249-2472
JPMorgan Chase Health Savings Account (Anthem Blue Cross)
  • Employer Group HSA Initiation Form
  • Employee 2005 Group Participant HSA Enrollment Package
  • Please do not submit an HSA contribution at this time. You will receive deposit slips in your HSA Welcome Kit
Submit the completed enrollment material to:
Anthem Blue Cross
Attention: HSA Enrollment
2000 Corporate Center Drive, Newbury Park, CA. 91320
Phone: (800) 627-8797
Mellon Bank - Anthem Blue Cross (Lumenos plans only)
  • HSA Client Agreement
  • Employer Statement of Understanding
  • Please do not submit an HSA contribution at this time. A member will receive deposit slips in their HSA Welcome kit.
Submit the completed enrollment material to:
Anthem Blue Cross
Attention: HSA Enrollment
2000 Corporate Center Drive, Newbury Park, CA. 91320
Phone: (800) 627-8797
The HSA for Life® Health Savings Account from Bank of America. (Health Net)
  • Bank of America Group Set Up Form
  • Bank of America Benefit Account Services Agreement
  • Authorization and Agreement for Services Form (1 page)
  • Authorization and Agreement Certification (1 page)
  • Benefit Account Services Delegation of Authority Form if applicable (1 page)
  • Please do not submit an HSA contribution at this time. You will receive instructions in your HSA Welcome Kit.
Completed forms may be faxed to 1.866.489.6706 or mailed to the following address:
Bank of America Health Savings Account
P.O. Box 69338 Harrisburg, PA 17106-9338
Employee Enrollment
Bank of America will provide the employer instructions on how to enroll their employees to The HSA for Life® program. The instructions listed below can be found in Health Net marketing collateral for Employees
.
Online HSA enrollment instructions for Employees of Employer Groups:
  • Visit www.bankofamerica.com/benefitslogin
  • Under New User, select Yes, and click Continue
  • Enter the Employer ID provided to you by your employer
    o The Employer ID must be 6-32 characters beginning with “HN” (example: for ABC Company it would be HNabccompany) and cannot contain spaces.
  • Follow the prompts to complete and submit your application
Mellon Financial HSA (PacifiCare)
  • Employer Discovery Document
  • Employee – Master Signature Card. Provided to a member by Mellon Bank once PacifiCare has transmitted the HDHP enrollment confirmation to Mellon Bank. This is the card a member should complete only if they wish to enroll. Each HDHP member will receive one automatically.
Submit the completed enrollment material to:
PacifiCare
5701 Katella Avenue, Mail stop: CY24-212 Cypress, CA. 90630
Phone: (714) 226-7779
Wells Fargo (Kaiser)
  • Wells Fargo Health Savings Account (HSA) Employer Application (6 pages)
  • Please do not submit an HSA contribution at this time. You will receive instructions in your HSA Welcome Kit.
Submit the completed enrollment material to:
Wells Fargo Health Benefit Services
NW 5613 P.O. Box 1450 Minneapolis, MN. 55485
Phone: (866) 890-8308
The Employer Sign-up form should be faxed to (920) 803-4184
Health Savings Accounts are regulated by the Internal Revenue Service. Be sure to understand all of the tax advantages and penalties involved with HSAs by consulting an accountant, certified financial planner or other qualified professional.