HSA Starter Kit

Health Savings Account (HSA) Starter Kit

In order to open your account, we will need the following:

  1. A completed Health Savings Account (HSA) Starter Kit.
  2. Copy of your driver’s license.
  3. Fund the account by Transfer, Rollover or Annual Contribution.
    • Transfer Form for each IRA from which we will be directly receiving funds – Watch Instructional Video HERE
      1. Statement for each IRA to be transferred.
    • Rollover Certification Form for each employer sponsored plan (401k, etc.) – Watch Instructional Video HERE
      1. Statement for each qualified plan to be rolled over.
    • Contribution Form
  4. $50 Account Establishment Fee.

For more information, please contact Mountain West IRA at 866-377-3311.

Please choose how you prefer to complete your HSA Starter Kit: