HSA Bank Debit Card
Access Your Debit Card Account Online
Make a Contribution
Account Maintenance Forms
HSA Bank Debit Card Fees
HSA Transfers and Rollovers
Tax-Related HSA Forms
HSA Legal Documents
You have indicated that you have a Debit Card issued by HSA Bank.
Access Your Debit Card Account Online
Please visit the HSA Bank site for real-time access to your debit card account.
Detailed instructions from HSA Bank are sent by mail to your home address when your debit card is issued.
Make a Contribution to Your HSA
- Click for the Existing Customer Contribution Form.
- The mailing address for sending your contributions (if you are not having them deducted from your pay check) is:
Health Savings Administrators
10800 Midlothian Turnpike, Suite 240
Richmond, VA 23235
Please make checks payable to Fulton Bank.
- Click for the ACH Debit Authorization Agreement. We can automatically make deposits to your HSA from your checking account. You can choose to have the money transferred on either the 1st or 20th of the month.
Account Maintenance Forms
- Click here for the Address Change Form.
- Click here for the Account Information Change Form to update other account information.
- To request a second Debit Card or checks, complete the Authorized Signer Form and return to Health Savings Administrators
- Click here for the Close Account Form.
HSA Bank Debit Card Fees
- For monthly account balances of $3,000 or more, there is no fee. For account balances that fall below $3,000, there is a monthly fee of $1.75.
- There is a $2.00 fee per transaction when you use your PIN. When making a purchase, ALWAYS specify CREDIT to avoid the $2.00 fee.
- For a complete list of fees please refer to the information provided in your Welcome Letter.
- Click here for a full listing of Debit card fees
Note: If you use the HSA Debit Card for non-medical expenses you will be subject to a 20% penalty and you will be responsible for the taxes on that debit card withdrawal. You also have the availability of paper checks. Manually processed reimbursement requests for debit card accounts are subject to a $10.00 handling fee.
HSA Transfers and Rollovers
- Click here for the Transfer Form. Use this form if you want your current HSA custodian to transfer your account to Health Savings Administrators but you have not received a check from your custodian.
- Click here for the Rollover Form. Use this form if your current HSA custodian has sent you a check that you want to deposit with Health Savings Administrators.
- Click here for the IRA to HSA Transfer Form.
Tax-Related HSA Forms
HSA Legal Documents
- E-Sign Agreement
Download information on electronic recordkeeping of disclosures, documents and statements. - Account Disclosures
Download disclosures associated with your HSA. - Interest Rates and Service Fees
- Online Banking Agreement
Download the agreement terms associated with using Internet Banking. - Privacy and Opt Out Notice
Download statements regarding your right to privacy.