EMPOWER
Participant Resources for HSA
Advanced Flex Plan Administration with the Human Touch

Participant Resources for the HSA

Table of Contents

Forms

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.

Additional Resources

Eligible Items

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.

EMPOWER Participant
Mobile App Download

If you have an FSA, HRA, or HSA with EMPOWER, we encourage you to
download the Mobile App to manage your benefits on the go!
Apple iOS
Google Android

EMPOWER LOGIN

I am a Participant
Click the above link if you are a participant who has an FSA, HSA, or HRA with EMPOWER.
I am an Employer
Click the above link if you are an Employer or Consultant.

Download Forms

Click one of the links below to view the available forms.

I am a Participant
Click the above link if you are a participant who has an FSA, HSA, or HRA with EMPOWER.
I am an Employer
Click the above link if you are an Employer or Consultant.