Fidelity hsa supplemental debit card application form
You can complete this form online and print it, or print it out first and complete by hand. Then, fax or mail it to the number or address below. This form works best with Acrobat Reader 7.0 ® or above.
Fidelity HSA® Supplemental Debit Card Application and Authorization and Indemnification Form
Use this form to enable an eligible spouse and/or dependent(s) to have a Supplemental Debit Card to...
Fill & Sign Online, Print, Email, Fax, or Download
Neither AFHSA nor American Fidelity Assurance Company are providing tax
advice. ... Additionally, an HSA may be used to pay for your own qualified
medical ... Medicare if you are 65 or older (but not Medicare supplemental
policies such as ...