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Members / Member Services and Account Management / Forms
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Forms
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As a service to our members, we make the most commonly requested forms available for download in an Adobe Acrobat portable document format (PDF).
 
~ Horizon MyWay HSA Forms
  Mellon HSA Employee Welcome Kit
This is an example, for illustrative purposes only, of the ACS/Mellon HSA Employee Welcome Kit. ACS/Mellon mails Welcome Kits to each employee as part of the Horizon MyWay HSA enrollment process. Prompt completion and return (to Mellon) of the Signature Card is required to establish an employee's HSA.
Adobe Acrobat Download
  HSA Investment
Mellon now offers an integrated platform which provides HSA account holders a seamless and affordable way to invest and grow their HSA dollars. The attached flyer provides an outline of the Mellon investment platform, which offers an easy to use online environment available 24 hours a day, 7 days a week.
Adobe Acrobat Download
  Mellon Deposit Slip
This form is to be used to deposit additional funds directly into a member's HSA account.
Adobe Acrobat Download
  Horizon MyWay HRA Claim Form Adobe Acrobat Download

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