BASIC HSA Administrative Forms

Throughout the Plan Year:

NEW! BASIC HSA Guide for Participants
Click here to open

HSA Enrollment Forms
Employees use this form to elect the amount they would like to have payroll deducted to contribute to their existing HSA account.

2018: Click here to open

2017: Click here to open

Fifth Third Bank HSA Application
New HSA Accounts at Fifth Third Bank are opened using this application.

2018: Click here to open

2017: Click here to open

HSA Participant Information Change Form

Complete this online form if an employee has a status changes such as an increase in election, change in per pay, termination of coverage or address change.
Click here to open

2018 HSA Renewal Materials:

Employer Renewal Information:

Return these forms to BASIC to complete your HSA Renewal:

        1. Employer HSA Renewal Information Form
        2. HSA Contribution Schedule
        3. HSA Enrollment Spreadsheet 

HSA Information for your reference:

Enrollment Tools:

  • Secure Upload

    Secure Upload

    upload icon Secure UploadIn compliance with Data Security Requirements, BASIC requests current clients, brokers, employees and participants use the link below to securely transmit your data to BASIC.

  • Tools & Resources

    Tools & Resources

    tools icon Tools & ResourcesBASIC is committed to providing our clients and brokers timely informative information regarding our industry and services we offer. Click below to access articles, calculators and free webinars.

  • Integrated HR Solutions

    Integrated HR Solutions

    integrated icon Integrated HR SolutionsBASIC is an integrated HR solutions provider established in 1989 and provides services to over 9,000 employers nationally. Employers with up to 30,000 employees trust BASIC with a wide range of HR responsibilities as a way to control cost, manage risk, and improve staff focus and effectiveness.

  • Regulations


    regulations icon RegulationsAvoid legal headaches by staying up to date on all rules & regulations regarding your plans.