Individual Application for a Health Savings Account ( HSA ) 2026

1. Click ‘Get Form’ to open the Individual Application for a Health Savings Account (HSA) in the editor.
2. Begin by filling out your Personal Information. Ensure you complete all required fields, including your First Name, Last Name, Street Address, City, State, Zip Code, Phone Number, Date of Birth, and Social Security Number.
3. Indicate your Residency Status by selecting either 'US Citizen' or 'Resident Alien'. Next, provide details about your Health Insurance Carrier and specify the Coverage Type as either 'Single' or 'Family'.
4. For the Opening Deposit section, ensure you meet the $100 minimum requirement. Specify the source of your funds and complete any necessary checks if applicable.
5. Review the Disclosures section carefully. By signing at the bottom of the form, you confirm that you have read and agree to these terms.
6. Finally, submit your completed application by mailing it to Wells Fargo Health Benefit Services along with any required payment.

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