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Get the free Health Savings Account Rollover Request Form

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What is HSA Rollover Form

The Health Savings Account Rollover Request Form is a personal finance document used by account holders to transfer funds from existing HSAs or MSAs into their HSA with Chase.

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Who needs HSA Rollover Form?

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HSA Rollover Form is needed by:
  • Current HSA account holders looking to transfer funds.
  • Individuals with MSAs seeking to roll over to an HSA.
  • Financial advisors assisting clients with HSAs.
  • Tax professionals aiding clients with health savings options.
  • Customers of Chase needing to manage account details.

How to fill out the HSA Rollover Form

  1. 1.
    Start by accessing pdfFiller and log in or create an account if you don’t have one.
  2. 2.
    Locate the Health Savings Account Rollover Request Form using the search bar.
  3. 3.
    Once you find the form, click on it to open it in the editor.
  4. 4.
    Begin filling in your personal information such as your Account Holder Name, Mailing Address, and Daytime Telephone Number in the appropriate fields.
  5. 5.
    Make sure you have your Social Security Number handy as this will be required.
  6. 6.
    Choose your account type by checking the relevant checkbox provided on the form.
  7. 7.
    Continue to fill in all required fields, ensuring all information is accurate and complete.
  8. 8.
    After completing the form, review each section carefully for errors or missing information.
  9. 9.
    Once verified, you can add your electronic signature in the designated signature line.
  10. 10.
    To save your progress, click the 'Save' button; you can also download the form to your device by clicking the 'Download' option.
  11. 11.
    Finally, if you’re ready to submit, print the completed form and gather any additional documents required, such as a check, before sending it to JPMorgan Chase Bank.
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FAQs

If you can't find what you're looking for, please contact us anytime!
Eligibility to use this form typically includes current HSA account holders and individuals who have Medical Savings Accounts wanting to transfer funds into an HSA with Chase.
Submissions of this form should be timely to coincide with any transfer requirements dictated by your previous financial institution; check with them for specific deadlines.
The completed form, along with any required checks or documents, should be mailed directly to JPMorgan Chase Bank for processing. Ensure all fields are complete before mailing.
Alongside the Health Savings Account Rollover Request Form, you may need to include a check for the amount being transferred, and any supporting documentation required by Chase.
Common mistakes include leaving required fields blank, providing incorrect information, or failing to sign the form. Double-check all entries for accuracy.
Processing times vary, but it generally takes a few weeks to complete the transfer once the form is submitted to JPMorgan Chase Bank. Check with your bank for specific timelines.
If you encounter problems, consult pdfFiller’s help section for support or consider contacting customer service for personalized assistance during the form completion process.
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