Forms & Documents General | Legal & Policy | HSA & Investment General How to File a Complaint Change of Personal Information Form Return Mistaken Contribution Form Member Electronic Transfer of Funds Form Start Legal & Policy Member Rights and Responsibilities Request Accounting PHI Disclosures Form Request to Amend PHI Authorization Disclose PHI Official Accident Form Official Disability Form Policy Privacy Notice Simplified Privacy Notice Beneficiary Designation Form Affidavit of Next of Kin CCPA Privacy Notice HIPAA Notice PHI Restriction Request Form Immediate Family Member Treatment Form Privacy Policy Request Access PHI Form Request Access PHI Form (Spanish) HSA & Investment Distribution Excess HSA Contribution Form HSA Letter of Medical Necessity HSA Partial Transfer Form HSA Closure Request Form HSA Rollover Request Form HSA Transfer Form Instructions Upon Divorce Mistaken HSA Distribution Form HSA Instructions Upon Death HSA Contribution Form HSA Letter of Medical Necessity HSA Reimbursement Form HSA Transfer Form (Spanish)
