Main HSA Page
Employer HSA

Thank you for your inquiry with Capitol Bank. Assisting your employee with setting up an HSA is as easy as 1, 2, 3! There are three steps that must be completed for each employee. We have put the forms all together for easy multiple printing and separated them for individual form needs. Please select one of the following and have your employee(s) fill out the necessary forms. You may send in all applications together, along with your deposit, and an indication of how the deposit should be split if more than one account is opened.

1. Print the forms and have the employees complete the customer information form, the contribution form, and page two of the account application (each employee retains the booklet).
2. Send completed forms, copies of employee driver's licenses and completed employer contribution worksheet (if applicable) to:
   Capitol Bank
   ATTN: HSA Services
   710 N. High Point Road
   Madison, WI 53717
3. Keep copies for your records.  We will send you a confirmation of receipt.

If you need assistance call (608) 836-1616 or email: newaccounts@capitolbank.com
Notice: E-mail is NOT a secure form of communication; therefore, NEVER e-mail any personal information (e.g. account numbers and social security numbers). Please contact a Personal Banker at 608-836-1616 (Madison) or 608-845-0108 (Verona).

Optional Forms:

Distribution  Use this form to define your distribution.

Change of Beneficiary  Use this form to change your beneficiary.

Rollover  The account holder receives the money through a distribution before rolling into an HSA at Capitol Bank from an Archer MSA or an HSA through another source. Rollovers from an IRA, HRA, or FSA are not permitted. Please call or email with questions.

Transfer  A direct movement from an Archer MSA or an HSA through another source to an HSA at Capitol Bank. Transfers are non-reportable transactions. Please call or email with questions.

IRS rules state that an HSA must have a trustee or custodian. Capitol Bank will
act as a custodian in the set-up of Health Savings Accounts.  Capitol Bank
does not sell insurance, give investment or tax advice.  All personal
information, including your email address, given to Capitol
Bank is confidential.

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