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Following is a check list of forms to complete, sign, date and submit to establish an HSA:
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Sterling HSA is a strategic partner with Warner Pacific for health savings accounts.
The professionals at Sterling are experts in the health benefits industry whose primary focus
is putting employers and consumers in control of their health care spending. Sterling can
provide administrative functions for any HSA compatible plan for any carrier.
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Employer Group Application
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Employer List Bill (if appropriate)
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Individual Sterling HSA Enrollment Form
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Beneficiary Designation Form
- Deposit check made payable to Sterling HSA
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Submit the completed enrollment material to:
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Aetna HealthFund Health Savings Account
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Aetna HealthFund Health Savings Account (HSA) Enrollment Form
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Aetna HealthFund Health Savings Account (HSA) Beneficiary Designation Form
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Aetna HealthFund Health Savings Account (HSA) Electronic Funds Transfer Authorization (EFT) forms
(if you wish to have your contributions transferred into your HSA directly from your checking account)
- Please do not submit an HSA contribution at this time. You will receive deposit slips in your HSA Welcome Kit
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Submit the completed enrollment material to:
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JPMorgan Chase Health Savings Account (Blue Cross)
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- Employer Group HSA Initiation Form
- Employee 2005 Group Participant HSA Enrollment Package
- Please do not submit an HSA contribution at this time. You will receive deposit slips in your HSA Welcome Kit
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Submit the completed enrollment material to:
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Mellon Financial HSA (PacifiCare)
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- Employer Discovery Document
- Employee – Master Signature Card. Provided to a member by Mellon Bank once PacifiCare has transmitted the HDHP enrollment confirmation to Mellon Bank. This is the card a member should complete only if they wish to enroll. Each HDHP member will receive one automatically.
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Submit the completed enrollment material to:
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