Health Savings Account

Send us your HSA paperwork

Tell us what you’re sending, drop the signed form in, and you’re done. It comes straight to ZyneraHealth as your HSA administrator — your employer never receives it and cannot see your HSA.

What are you sending?

Pick the document and we’ll tell you exactly what it does and what has to be on it.

Document type Choose the document you’re sending.

I already have the form Your new custodian gave you a transfer request to sign. Drop it in below. I don’t have a form — write one for me Answer four questions and we’ll produce the signed request ourselves. Most custodians accept it, and it’s the fastest route.

Bringing an HSA to us instead?

Then there’s nothing to upload here. Your current custodian starts that transfer, and they need our account information to do it. Start an incoming transfer and we’ll write the form for you.

Your signed form

The form itself carries the custodian, account number, amount and your signature — so there’s nothing to re-type here.

Drag your signed form here or PDF, JPG, PNG or HEIC · up to 10 MB each · 5 files max

Attach your signed transfer form before submitting.

Check before you send: The whole page in frame, in focus, signed and dated, with the account number legible. A cropped or blurry form is the most common reason a transfer stalls.

Who’s sending it

Just enough to match the form to your account and send your confirmation.

Your employer This tells us which plan your HSA belongs to. Enter the employer whose plan your HSA is under.

First name Enter your first name as it appears on your HSA.

Last name Enter your last name as it appears on your HSA.

Employer employee ID On your pay stub. Enter your employee ID.

Email Your timestamped confirmation goes here. Enter an email address we can reach you at, like name@example.com.

Phone Enter a phone number in case we need to reach you about this transfer.

Anything we should know optional

The document I’m sending is complete and signed where required, and I authorize ZyneraHealth to act on it for my HSA.

You’ll get a timestamped confirmation on screen and by email.