Documents and Forms
For the convenience of our clients–brokers and consultants, employers and individual subscribers–a number of key documents and forms can be downloaded and printed from this site.
The following files require Adobe Acrobat Reader – free software for viewing and printing PDF files.
General Information
- Frequently Asked Questions (PDF, 73K)
- HSA How to Guide (PDF, 68K)
- HSA Administrative Instructions (PDF, 68K)
- Standard Plan Fee Schedule (PDF, 57K)
- eSavings Fee Schedule (PDF, 60K)
- Steps to Set Up Account (PDF, 54K)
For Employers
- Employer Group Application (PDF, 60K)
- Employer Application Kit (PDF, 142K)
- List Bill (PDF, 78K)
- List Bill (XLS, 35K)
- Lifespring Service Packages & Fees (PDF, 68K)
- Employer Checklist (PDF, 31K)
For New Subscribers to Enroll
- Individual Enrollment Application (PDF, 109K)
- Individual Enrollment Kit (PDF, 234K)
For Current Account Holders
- Request for Debit Card Form (PDF, 22K)
- Deposit Form (PDF, 46K)
- Request for Funds Disbursement Form (PDF, 41K)
- Beneficiary Designation Form (PDF, 53K)
- Account Change Form (PDF, 57K)
- Account Termination Form (PDF, 36K)
- Roll-Over Request Form (PDF, 42K)
Account Agreements
- Administrative Agreement (PDF, 37K)
- Custodial Agreement (PDF, 42K)
For Self Directed Investment Information
- Transfer of Assets Form (PDF, 80K)
- Third Party Release Form (PDF, 34K)
- Lifespring Health as Interested Party (PDF, 50K)