Updating and Changing HSA

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Home > Small Business > Solutions > Plan for Your Future > Health Savings Account > Updating and Changing HSA

Updating & Changing HSA

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.

1. Listed below are the forms needed to update or change your Health Savings Account at Provident.

Form Options: There are two choices for filling out the Providents HSA forms:

You can type in your answers online and then print the forms or
You can print all necessary forms and write in your informaton.

You will need Adobe Acrobat Reader® to view and print the forms:

Questions? Please call 1-866-709-1HSA(472), Option 1.

I want to

Forms

Contribute to my HSA

Contribution

Withdrawal from my HSA

Withdrawal

Rollover HSA funds
(If you have withdrawn money from an HSA and want to deposit it in a HSA, use this form.)

Rollover

Transfer HSA funds
(If you want the to transfer Health Savings Account funds between institutions and want to instruct the institution to make the transfer, use this form.)

Transfer

Update, add or change my HSA beneficiary(ies)

Beneficiary

Order a HSA Debit Card
(Lost or stolen HSA Debit Card? Click here.)

Debit Card

Forms of Identification

Identification

2. Please mail the signed forms to the address below:

Provident Bank
EFT Department
P.O. Box 1661 Mail Code: 213
Baltimore, MD 21203-1661

You may want to make a copy for your records of any Health Savings Accounts forms before you send.

3. If you are sending a check, please make it payable to Provident Bank.

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