General Forms
FirstHSA Health Savings Account Application (PDF, 32k)
Business Associate Agreement (PDF, 53k)
Commission Scale (PDF, 31k)
CPA Lawyer Attestation Form (PDF, 92k)
Small Group Employer Request for Coverage PH-2000 (PDF, 23k)
Large Group Request for Coverage PH-3000 (PDF, 36k)
HRA Authorization Form (Word, 165k)
Employee Enrollment and Change Form (PDF, 71k)
Producer Commission Agreement PerfectHealth (PDF, 21k)
Producer Information (PDF, 22k)
Waiver of Coverage (PDF, 90k)
W9 Form (PDF, 32k)

Information
What forms are needed to submit an HRA case?
Employer Application
Employee Application
Waiver Forms
Prior carrier bill and proof of 12 months prior coverage
Copy of HRA application
Copy of HRA Plan Document
HRA Authorization Forms
Check payable to PerfectHealth equal to first months premium
Signed copy of final proposal
Current signed tax evidence
Verification of dependents over upper age limit (handicap – F/T student)

How to Reach Us (PDF, 30k)