Employer Forms
Please download and print the Employer Enrollment Form . Complete and return pages 3-9 (Employer Information Form, Bank Account Form and Administration Agreement) to BASIC by fax or mail.

Please download and complete the HSA Employee Contribution Spreadsheet . Once that is completed, email to HSA@basiconline.com

Employer Enrollment Form
HSA Employee Contribution Spreadsheet

Employee Forms
Please download and print the Employee Enrollment Form . Complete and return pages 1-3 (Employee Worksheet and HSA Application) to your Human Resource Department or Benefits Coordinator.
Employee Enrollment Form for 2007
Employee Enrollment Form for 2008

Individual Forms
Please download and print the Individual Enrollment Form . Complete and return pages 3-5 (Bank Account Form and HSA Application) to BASIC by fax or mail.
Individual Enrollment Form for 2007
Individual Enrollment Form for 2008

Rollover Form
Use this form to rollover an existing HSA, MSA, or IRA. Please download and print the Rollover Enrollment Form. Complete and return to BASIC by fax or mail.
HSA Rollover Enrollment Form