Employee Waiver

If you are a small business owner (employer), and have employees who are not participating in your insurance plan, a waiver must be submitted for each employee.

Download the waiver below, one waiver for each employee who is not participating in the plan. Email the completed waiver to salessupport@hsainsurance.com. In the subject line of your email reference your account number, account name and “waiver.”

HSA Unified Waiver and Verification of Coverage

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