Thank you for choosing Provident Bank for your Health Savings account. At Provident, you get all of the products, services and technology of a large bank, with the caring customer service you would expect from a small bank. It’s the next best thing to having your own bank.
Health Savings Account Enrollment:
1. Please use the New Health Savings Account Check List below to make sure you have all information needed to open an account. Click on the New HSA Account form (see your form options below) and the Rollover or Transfer forms (if necessary). Please make sure you sign all the forms. You will need Adobe Acrobat Reader® to view, fill in and print the forms:
Form Options: There are two choices for filling out the Providents HSA forms:
- You can type in your answers online and then print forms or
- You can print all necessary forms and write in your informaton.
| | Learn More |
| New Health Savings Account Check List | New HSA Account |
| Health Savings Account (HSA) Application |
| Health Savings Eligibility and Information |
| | Debit Card Application |
| | Proof of Identification |
| | Signature Card |
| Rollover
(This form is only needed if you are rolling over funds from another Health Savings Account.) | Rollover |
| Transfer
(If you transfer Health Savings Account funds from another institution and want to instruct the institution to make the transfer, use this form.) | Transfer |
2. Fill out and sign all appropriate forms.
3. Add a check for $25.00 (account set-up fee) made payable to "Provident Bank."
4. Mail the Health Savings forms and check to:
Provident Bank
ProvidentDirect
P.O.Box 1661, Mail Code: 829
Baltimore, MD 21203-1661
You may want to make a copy of the Health Savings Accounts forms before you send the application for your records.
Self-Directed Investment Option Enrollment
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