email
download
11.16.2011
Optum HSA - Bank Rollover form
Form to be completed by an employee who wishes to enroll into an Optum HSA account, and currently has a HSA bank account through another vendor. This will allow transfer of HSA funds from vendor to vendor.
email
download
11.16.2011
Optum HSA - Employer Setup form
Form to be completed by the employer, if they wish to sponsor an HSA account for their employees; whether with employer contribution or allowing for pre-tax contributions.
email
download
11.16.2011
HRA Benefit Form
UHC branded form to be completed by Employer, when they are funding an HRA account for their employees. This form is how they elect how the plan will distribute funds, how much per employee, and if rollover.
Email Document
(800) 561-0510 | + (215) 561-0510