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.
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.
