Open a Health Savings Account (HSA)

Please complete the three sections below to obtain all the forms and disclosures necessary to open an HSA. You will be instructed as to which forms should be completed and returned to Alliant and which should be retained for your personal records. Upon receiving your completed forms, we will open your account.

You must be a member of Alliant to open an HSA account. Membership application.

Type of Contribution

Open with a Zero Balance
(Payroll deposits will be forwarded from my employer. Once your HSA is opened a confirmation letter will be sent to you that will include your 14 digit HSA account number & our ABA routing number.)

Employee or Employer Annual Contribution
(Prior year contribution or current year contribution.)

Rollover from Another HSA
(Funds originally came from an HSA and are being deposited within 60 days.)

HSA Direct Transfer from Another Financial Institution
(The Request to Transfer HSA to Alliant form should be completed and sent to the financial institution that currently provides your HSA.)




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