Advanced Flex Plan Administration with the Human Touch
Resources for HSAs
This page shows resources to help you administer your EMPOWER HSA. If you would like to view our Enrollment Resources page that has helpful information for enrollment, click the link below.
Table of Contents
Forms
Participant Forms
Name
Description
English
Spanish
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 participants must either accept the HSA terms on the Online Portal or sign this form and return the last page to EMPOWER.
HSA Enrollment Form
This is an enrollment form that you may distribute to your employees.
HSA Transfer Form
Form to transfer the balance from another account to the participant’s current EMPOWER HSA account.
Employer Forms
Name
Description
English
Spanish
Nondiscrimination Questionnaire
Form for Employers to submit information for nondiscrimination testing.
Enrollment Methods
Name
Description
English
Spanish
Enrollment Spreadsheet
Use this link to download the enrollment spreadsheet to send you enrollments to EMPOWER.
EMPOWERConnect
EMPOWERConnect is an optional service that automatically integrates with your HRIS or Payroll system.
Instructional Guides
Participant Instructional Guides
Name
Description
English
Spanish
HSA Welcome Guide (PDF)
PDF guide that details the HSA Plan for new participants.
Coming Soon
Employer Instructional Guides
Name
Description
English
Spanish
Employer Welcome Guides
Guides are available that explain how to administer your EMPOWER Plan.
You will receive guides when setting up a new plan and during open-enrollment. Ask your Account Administrator for additional information.
Employer Portal Quick Start Guide
Use this guide to learn how to use the Employer Online Portal.
Additional Resources
Participant Resources
Name
Description
English
Spanish
