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Advanced Flex Plan Administration with the Human Touch
Participant Resources for the HSA
Table of Contents
EMPOWER encourages you to use the Online Portal to ensure the fastest service (see the Instructional Guides and Tutorials section below for more information). However, forms are provided below for you to fill out and return to EMPOWER as an alternate way to use your benefits.
Direct Deposit Authorization Form
Add or change an existing bank account to receive reimbursements right to your bank account
HSA Beneficiary Form
Use this form to add or change an HSA beneficiary.
HSA Claim Form
Use this form to submit an HSA claim.
HSA Contribution Change Form
Use this form to make a change to your HSA contributions.
HSA Contribution Form
Use this form to make an HSA contribution outside of your Employer’s payroll.
HSA Custodial Agreement
All HSA Consumers must either accept the HSA terms on the Consumer portal or sign this form and return the last page to EMPOWER.
HSA Transfer Form
Form to transfer the balance from another account to your current EMPOWER HSA account.
List of eligible items for all plans.
HSA Investment Options
List of HSA investment options.
Instructional Guides and Tutorials
HSA Welcome Guide
Comprehensive guide to using your EMPOWER HSA.
HSA Welcome Page (Online)
Comprehensive online guide to using your EMPOWER HSA.
Online Portal Quick Start Guide
Learn how to use the Online Portal.