employer/benefits administrator
 

General Forms
FirstHSA Health Savings Account Application (Word, 130k)
CPA Lawyer Attestation Form (PDF, 92k)
Small Group Employer Request for Coverage PH-2000 (PDF, 23k)

Large Group Request for Coverage PH-3000 (PDF, 37k)
ID Card (PDF, 38k)
PH Employee Enrollment and Change Form (Word, 125k)
Waiver of Coverage (PDF, 90k)
FirstHSA Employer Contribution Worksheet (Excel, 74k)
W9 Form (PDF, 32k)

Information
Employer Capabilities Booklet (PDF, 2.5m)
PerfectHealth Employer: Benefits at-a-Glance (PDF, 221k)
PerfectHealth Plan Strategies: Benefits at-a-Glance (PDF, 216k)
PerfectHealth HSA Plan Contribution Limits (PDF, 307k)
EOB-Explanation (PDF, 35k)
Healthcare Fraud (PDF, 51k)
HSA Qualified Medical Expenses (PDF, 32k)
Notice of Our Information Privacy Policies and Practices (PDF, 32k)
Notice of Privacy Practices (PDF, 56k)
Notice of Women's Health & Cancer Rights (PDF, 26k)

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