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Alerus Health Savings Account Transfer Request Form 2016 free printable template

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HEALTH SAVINGS ACCOUNT TRANSFER REQUEST FORM INSTRUCTIONS Use this form to initiate a direct transfer of funds from your HSA with another trustee/custodian to an HSA with Alerts Retirement and Benefits
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How to fill out Alerus Health Savings Account Transfer Request

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How to fill out Alerus Health Savings Account Transfer Request Form

01
Obtain the Alerus Health Savings Account Transfer Request Form from the Alerus website or your account representative.
02
Fill in your personal information, including your name, address, and account number.
03
Provide details of the HSA you are transferring from, including the institution’s name and account number.
04
Indicate the amount you wish to transfer (all or partial amount).
05
Sign and date the form to authorize the transfer.
06
Send the completed form to Alerus as instructed, either via mail or electronically.

Who needs Alerus Health Savings Account Transfer Request Form?

01
Individuals who want to transfer their Health Savings Account (HSA) funds from another financial institution to Alerus.
02
People who have changed jobs and wish to consolidate their HSA accounts.
03
Anyone looking to take advantage of Alerus’s features and benefits for their health savings.
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The My Alerus app helps you manage your entire financial life in one place. Within the app, you can access easy to follow set of steps that guides you on your path to financial confidence.
We offer a number of ways to get in touch with us, or you may call our client service center at 800.279. 3200.
Note: to reach your retirement account from the My Alerus homepage, select your plan under Retirement and click the Plan Summary link on the right side of the page. Select Distribution Center from the left side menu. Select your distribution from the options available to you.
You are allowed to make withdrawals from your account under certain circumstances. The fees indicated will be deducted from your account to process each distribution you request. An outstanding loan balance may lower the amount of your requested distribution.
The Alerus Health Benefits Card draws funds directly from your health benefits account to pay for eligible expenses. It can only be used at places where you might obtain medical, dental, vision, dependent care, parking, or transit services (please check your plan for covered benefits) with providers accepting Visa®.
The fee for the Managed Account Program is 0.45 percent prorated over 365 days and applied to the average daily balance of your managed account. The fee is accrued daily and collected monthly. On an annual basis, the fee equals approximately $4.50 for each $1,000 invested.

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The Alerus Health Savings Account Transfer Request Form is a document used to request the transfer of funds from one Health Savings Account (HSA) to another HSA managed by Alerus.
Individuals who wish to transfer their funds from an existing HSA to an Alerus-managed HSA are required to file the Alerus Health Savings Account Transfer Request Form.
To fill out the form, individuals need to provide their personal information, details of the current HSA, specify the amount to be transferred, and sign the form to authorize the transfer.
The purpose of the form is to facilitate the transfer of funds from one HSA to another, ensuring that the transfer process is officially documented and authorized.
The form must report the account holder's personal information, the details of the existing HSA (including the institution and account number), the requested transfer amount, and a signature for authorization.
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