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Administrative Services Agreement This Administrative Services Agreement is made between Sterling Health Services, Inc. and the individual who signs the Sterling HSA Enrollment Form., 6 Pages (Rev. 12/2011)
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Application Employer Group 2 Pages (Rev. 4/2011)
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Beneficiary Designation Form Beneficiary designation to be made by all applicants, 2 Pages (Rev. 11-2011)
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Change Request Form To change account information, 1 Page (Rev. 11/2011)
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Custodial Agreement This Custodial Agreement is made between CitizensTrust, and individual who signs the Sterling HSA Enrollment Form, 5 Pages (Rev. 4/2011)
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Deposit Form Deposit Form – Individual HSA Contribution, 1 Page (Rev. 12/2011)
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Employee Enrollment Kit How to Set-up a HSA Account, 13 Pages (Rev. 12/2011)
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Employee Payroll Deduction Salary Redirection Agreement for Health Savings Account, 1 Page (Rev. 7/2011)
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Employer ACH Authorization Form Credit / Debit Authorization Form, 1 Page (Rev. 7-10)
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Employer Enrollment Kit An employer's "How To" kit, 5 Pages (Rev. 12/2011)
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Guide to Tax Related HSA Questions Sterling does not give tax advice, consider these as informed guidelines. Specific tax questions should be referred to your CPA or tax preparer., 1 Page (Rev. 12/2011)
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Health Savings Account Administration Instructions 6 Pages (Rev. 2/2011)
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Request for Debit Card To request debit card, 1 Page (Rev. 9-2010)
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Request for Disbursement To request disbursements, 1 Page (Rev. 3/2011)
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Sterling Service Packages & Fees 1 Page (Rev. 8/2011)
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Terminate Account Form To close your account with Sterling HSA, 1 Page (Rev. 8/2011)
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Sample Eligible Expenses Sample expenses list - intended as a quick reference guide only. For a list of qualified HSA expenses please see IRS Publication 502 Section 213 (d).
(Rev. 6-2011)
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POP Application 6 Pages (Rev. 11/2011)
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POP Brochure Section 125 Premium Only Plans, often referred to as POP Plans, reduce income tax liabilities for employers
and employees., 2 Pages (Rev. 8/2010)
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POP Election Form Election Form to Participate in Section 125 Premium Only Plan, 1 Page (Rev. 11/2011)
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POP Participant (Rev. 10/2010)
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For additional information, please contact Claremont at 800.696.4543
or
info@claremontcompanies.com