HSA Forms
If you would like to contact us, please feel free to call 1.866.856.6799, ext 201, or complete the contact request form.
For Personal & Business HSA’s in Ontario, here is the list of forms that need to be completed:
- Schedule ‘A’ (click here for printable version)
- Trust Agreement (printable)
- Employee Enrollment Form (one per employee) (printable)
- HSAComplete Optional Catastrophic coverage (printable)
- Please note that the minimum monthly contribution is $50 per employee.
Other administrative forms:
- Claim Form (printable)
- Direct Deposit for Reimbursements (printable)
- HSA Pre-Authorized Payment Form (printable)
It is adviseable to call us for assistance at 1.866.856.6799, ext 201.
Please mail forms to us at:
Benefits Ontario (Benecaid enrollments)
52 Ryans Way
Waterdown, Ontario L0R 2H5
You’ve made a smart decision for your benefit needs!
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