- Withdrawal Request Form (UMB)
- Request a withdrawal from your UMB Health Savings Account
- Name Change Form (UMB)
- Form to change the name associated with your Health Savings Account.
- Transfer Form (UMB)
- Form for transferring your account to UMB from another trustee
- Beneficiary Form (UMB)
- Designate the beneficiary for your Health Savings Account.
- Over-The-Counter (OTC) Chart
- Sample chart of OTC items that may be eligible from your HSA.
- Medical Necessity Directive Form HSA
- To use for personal documentation of medical services/items, such as over-the-counter medicines and drugs, that require additional documentation from a licensed health care provider. (Retain for your records.)
- Enrollment/Change Form HSA
- To enroll or make changes in your HSA program.
- Direct Deposit Form
- This form allows an employer, or other organization, to establish direct deposit into your HSA.
- Change of Contact Information (UMB)
- This form can be used to update your name, email address, telephone number, and home address information for your HSA to UMB Financial Corporation.