Required HSA Forms

Open your Health Savings Account Today!

In order to take advantage of the benefits of a Health Savings Account, you need to be enrolled in an HSA-eligible health insurance also referred to as a High Deductible Health Plan (HDHP). After you are approved for insurance, you can open an HSA with Stanford FCU. Remember, a Stanford FCU HSA is available to anyone, not just Stanford employees.

How to Apply

Already a member:

Print and complete these forms:
HSA Custodial Application
Stanford FCU HSA Disclosure & Agreement
HSA Contribution Direction
HSA Contribution Eligibility

Not a member:

In order to open a Health Saving Account with Stanford FCU you will need to become a member.

  • Join Stanford FCU by completing our online membership application
  • Open a share savings or checking account with a minimum of $5.00
  • Print and complete HSA forms above

Health Savings Accounts are provided to those members who are employed with one of our Select Employer Groups (SEGs). Members who qualify through FOPAL/MOAH must go into one of our branches to be eligible for this product.

Transferring Existing Health Savings Account

To transfer your pre-existing, if applicable, HSA from another institution to Stanford FCU, please complete the following forms:
HSA Direct Transfer Instructions
HSA Rollover and Transfer Form
HSA Custodial Application if plan not established – this form is required
Stanford FCU HSA Disclosure & Agreement

Submit all of these forms with a copy of your current Health Savings Account statement

General Instructions:

Please make sure to designate at least one beneficiary and sign all forms.
Once you have competed all required forms, return them to Stanford FCU, keeping a copy of each form for your records.

You can return completed forms at any of our branch locations.

We also accept completed forms via:

Fax:  866.799.8218

Mail: Stanford Federal Credit Union, P.O. Box 10690, Palo Alto, CA 94303-0843

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