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HomeFormsBenefits formsHealth Savings Account (HSA) Death Beneficiary Change
Form
ARTICLEPROD-2372
Health Savings Account (HSA) Death Beneficiary Change Form
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Use the Health Savings Account (HSA) Death Beneficiary Change Form to make
changes to your beneficiary designations.

Important: To process this form, notarization may be required.

To add a trust as a beneficiary, complete this form and provide your trust
documentation.



To add a charity as a beneficiary, complete this form and ensure that the
charity’s Tax Identification Number (TIN) or Tax ID is included in lieu of the
social security number in Step 2.





Scenario

Resolution

The “I am married” box is checked under Step 3.

Notarization is required.




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form. You can get Adobe Acrobat Reader for free from the Adobe website.






> Article ID: PROD-2372
> Health Savings Account (HSA) Death Beneficiary Change Form


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https://wexbenefitskb.egain.cloud/system/templates/selfservice/dbinv/help/customer/locale/en-US/portal/308900000001012/content/PROD-2372/Health-Savings-Account-HSA-Death-Beneficiary-Change-Form

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