Health Savings Account (HSA) Forms
If you are enrolled in a Principal High Deductible Health Plan through your employer, or your employer is providing a Principal HSA, please use the link on your company website to apply online, or the forms provided by your employer.
Apply here if you are not applying for a Principal HSA through your employer.
HSA CD Application (PDF: 101 KB)
Use this form to set up a Principal Bank Certificate of Deposit.
HSA Authorized Signer Form (PDF: 76 KB)
Use this form to designate an Authorized Signer for your Principal HSA. Your Authorized Signer will have the right to transact business for your Health Savings Account, including making deposits, writing checks and using a debit card.
Change of Beneficiary Form (PDF: 125 KB)
Designate additional beneficiaries or change your beneficiary for your HSA.
Request for Direct Transfer Form (PDF: 18 KB)
Complete this form to transfer a Medical Savings Account (Archer MSA), IRA (one-time only) or another HSA to a Principal Health Savings Account. Simply complete this form and mail to Principal Bank along with a completed Custodial and Enrollment Form - we'll take care of the rest.
Rollover Contribution Form (PDF: 86 KB)
Use this form to assist with rolling over funds, which you have already received from your Archer MSA or another HSA. Complete the Rollover Contribution Form, plus the Custodial and Enrollment Form, and mail to Principal Bank along with a your MSA or HSA rollover funds.
HSA Disclosures
Principal Bank Terms and Conditions (PDF: 166 KB)
Principal Bank Schedule of Fees (PDF: 62 KB)
