Administrator Forms
If you are an employer or consultant looking to add a new benefit offering or add a new plan, please visit our Setup Forms page. Please note that there may need to be an addendum to your administrative agreement with ABG and administrative fees.
Commuter Benefit Election & Change Form
Commuter Transit, Parking, and Bicycle Election Form
Flexible Spending Accounts - Election Form
Flexible Spending Accounts - Election Form - Spanish
Health Flexible Spending Account - Election Form
Flexible Spending Accounts & LPF - Election Form
Flexible Spending Accounts & Commuter - Election Form
Flexible Spending Accounts & Commuter - Election Form - Spanish
Health Flexible Spending Accounts & Commuter - Election Form
Dependent Care Assistance Plan - Election Form
Health Reimbursement Arrangement - Enrollment Form
ICHRA - Enrollment Form
Health Savings Account - Enrollment form
Flexible Spending Account - Qualified Status Change
Health FSA - Carryover Balance Waived Form
Direct Deposit Authorization
Dependent Card Application
Employee Termination
HSA Transfer to Avidia Bank
Employer Avidia HSA Contribution Correction Form
Electronic Records Disclosure and Agreement
Privacy Disclosure
Authorized Signer
Beneficiary Form
Contribution Correction Form
Distribution Reversal Form
Contribution Change Form (to change per pay period contributions)
Change Form (including beneficiaries, authorized signer, and demographics)
Individual Contribution Form (to transfer money to your HSA)
Account Closure Form
Death Distribution Form
Avidia Bank Fees
Reactivate Dormant HSA Bank Account
Welcome Guide
Bank Disclosures
Fees Associated with Your HSA Account
Beneficiary Form
Transfer Form
Authorized Signer
Close Account
Contribution Correction
Contribution Correction - Change Year
Contribution & Return of Mistaken Distribution Form
Employer WealthCare Saver HSA Contribution Correction Form
Investment Guide
Investments - Getting Started
Distribution of Excess Contributions
Power of Attorney