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Setting up a health savings account is simple. When you need a form to set up transactions or change your personal information, Avidia Health is here to help. Find electronic and printable forms below.
|Account Maintenance||E-Form Mailed Form|
|Authorized Signer Form||E-Form Mailed Form|
|Beneficiary Form||E-Form Mailed Form|
|Check Order Form||E-Form Mailed Form|
|Contribution (Excess) Form||Mailed Form|
|Contribution (Individual) Form||Mailed Form|
|Contribution Correction Form||E-Form Mailed Form|
|Distribution Reversal Form||Mailed Form|
|Eligibility Form||Mailed Form|
|Health Savings Authorization for Payroll Deduction||Mailed Form|
|Individual Enrollment Form||E-Form Mailed Form|
|IRA Transfer Form||Mailed Form|
|Rollover Form||Mailed Form|
|Transfer Form||E-Form Mailed Form|
|Withdrawal Form||Mailed Form|
If you need additional assistance, contact us directly and we’ll be glad to send you the forms: 855.472.9399 or HSAinfo@avidiabank.com.
Please complete the form below and an Avidia representative will contact your shortly.
Thank you for your interest in opening up an Avidia Health HSA account. An Account Representative will be contacting you shortly.