HSA Account Transfer Form

Home Contact Us Login HSA Transfer Request FormTo request a HSA Transfer or Rollover from a prior custodian, complete this form and submit to DataPath Financial Services. An account transfer, or rollover, is how money or property can be moved to Summit from a Health Savings Account (HSA) or Medical Savings Account (MSA) previously held elsewhere. The … More >>

HSA Election Change Form

Home Contact Us Login HSA Election Change FormComplete this form to request a change in your HSA contributions.Instructions1.  Download and complete this form. Be sure to sign it.2.  Submit the completed form to DataPath Administrative Services in one of three ways:     • Email the form to abb@datapathadmin.com with the subject line “HSA Election Change”     • … More >>

FSA Dependent Care Recurring Expense Claim Form

Home Contact Us Login Dependent Care Recurring Expense FormComplete this form to request automatic reimbursement from your Dependent Care Assistance Plan (DCAP) account.By submitting this form you can arrange for your DCAP contributions to be reimbursed to you automatically on a per-pay-period basis without having to submit new documentation each time. You must complete all sections … More >>

FSA Claim Form (Debit Card Substantiation or Reimbursement)

Home Contact Us Login FSA Claim Form and Debit Card Substantiation Request FormSubmit this form to substantiate a debit card transaction, or to claim FSA reimbursement for an out-of-pocket expense. Section 1: Employee Information​The following information must be included:     • Employee Name     • Employee Address     • Employee Social Security Number     • Employee Phone Number     • Employee … More >>