HSA Forms and Online Resources
The links below are provided for your benefit and Fifth Third Bank HSA does not guarantee the accuracy of the information provided:
Account Information Change Request
Most of the information can be updated online, but you can use this form to update your personal information, your bank account information, and more.
Use this form to add or make changes to the beneficiary(ies) associated with your HSA.
Contribution Form (mail-in) For Individuals
HSA contributions can be made online, or you can use this contribution form and mail in a check.
Death Distribution Request
If you are the beneficiary of an HSA, use this form to request distribution of HSA funds after the passing of an account holder.
HSA Transfer Form
To transfer an existing HSA or IRA to a FifthThird Bank HSA
Over Contribution Correction Request
If you contribute more to your HSA during the tax year than the annual published limits, use this form to correct the overage.
HSA Consumer Resource Guide
Easy to follow reference manual to help navigate your online HSA Consumer portal (printable PDF format).
HSA Consumer Resource E-Guide
The HSA Consumer Resource Guide presented in an e-guide format.
Changes to Your HSA Investment Options
Upcoming changes to your HSA Investment Options
HSA Employer Portal
Linkto the HSA Employer Portal where you can upload contributions, view employee enrollments, obtain reports, access HSA forms, and much more.
Profile Change Form
To make changes to your company profile: name, TIN, address, contacts, authorized portal users, bank account information.
Division Request Form
To create divisions within your company profile, such as full time vs. part time, family coverage vs. single coverage, etc.
Employer Reversal Form
To reverse a processed contribution that postedto an Employee account in error.
Employer Mail-in Contribution Form
To submit an Employer contribution by check.
Fee Responsibility Form
To change who is responsible for paying the one-time enrollment fee and/or the monthly maintenance fee (Employer or Employee).
HSA Employer Resource Guide
Easy-to-follow reference manual to help navigate the HSA Employer portal (printable PDF format).
HSA Employer Resource E-Guide
The HSA Employer Resource Guide presented in an e-guide format.
Benefit Season Letter
This semi-customizable letter can be distributed to your employees in preparation for the benefit season.
Open Enrollment Poster
This poster can be customized and displayed within your building to announce and/or remind employees of upcoming benefit meetings.
Open Enrollment Presentation
Use this presentation during your open enrollment season to begin educating your employees on HSAs.
HSA Reminder Slip
You can distribute this slip to your employees to generate excitement for HSAs
Provides features and benefits of the Fifth Third Bank HSA solution.
HSA Start Up Sheet
Everything your employees need to know to open their HSA and start saving for healthcare expenses.
HSA Consumer Prospect Brochure
Use this brochure for Employees that have not yet decided to enroll in the HDHP/HSA solution and need basic information on how it works.
HSA Consumer New Account Brochure
Use this brochure for Employees that have made the decision to switch to the HDHP/HSA solution to help answer initial questions.
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