Completing the Employer Sign-up Form is the first step to getting your HSA program up and running! By completing this form, you will gain access to HSA Bank’s employer site, which is designed to help you manage your benefits program. The site allows you to contribute to your employees’ HSAs, manage your list of employees, access education materials, and much more.
Within 2 business days after submitting the below form, a summary of your enrollment and contribution options will be emailed to you. If you have questions, or if you are interested in learning more about our full CDH product suite, contact a Business Relations Representative at (866) 357-5232, Monday through Friday, 7 a.m. to 7 p.m., Central Time.
Click here to sign up by mail.
Company Information
Please provide us with your complete, legal company name (do not include your “Doing Business As” or operating names). This will help to ensure accurate and timely processing.
Select Primary Contact
The Primary Contact is an employee within your company who will have full administrative privileges in the employer site. These privileges include the ability to add administrative users and assign permissions to administrative users.
Set-up Preferences
This authorization is to remain in full force and effect until HSA Bank has received written notification from me (or either of us) of its termination in such time and in such manner as to afford HSA Bank and DEPOSITORY a reasonable opportunity to act on it.
NOTE: ALL WRITTEN DEBIT AUTHORIZATIONS MUST PROVIDE THAT THE RECEIVER MAY REVOKE THE AUTHORIZATION ONLY BY NOTIFYING THE ORIGINATOR IN THE MANNER SPECIFIED IN THE AUTHORIZATION.
Referral Tracking Codes
If you were not provided any referral tracking codes, please leave the below fields blank.