Your employees can sign up for Health Savings Accounts by clicking on the red Open An Account button to the left.

It is important for employees to identify their employer (Company Name) and to enter the agent's full name in the Promo Code box, if known.

Maintenance Fee
A monthly maintenance fee of $1.00 is waived on the first year.

HSA Checks
Effective July 1, 2009, the price for a box of 150 HSA checks is $7.95.

The HSA must have funds before checks can be ordered.

HSA Owners (or your employees) can place their new check orders after contributions to their accounts have posted.

HSA Owners who qualify for the HSA Debit Card and who want HSA checks as well may place their check orders by calling 800-358-8228.

The HSA Debit Card is free of charge.

Employer Contributions
There are several ways to contribute to your employees' Health Savings Accounts:

• By check through the mail
• By ACH/Direct Deposit
• At a local Patelco branch
• Online

By Check
The accounts must be opened first before you can contribute to your employees' HSAs.

The Employer Contribution form must list the names of employees, their Health Savings Account numbers and the funds to be contributed to their accounts.

Send the Employer Contribution form along with the contribution check to:

By ACH/Direct Deposit
The Employer authorizes their Bank to initiate the ACH/Direct Deposit (where the Bank debits the Employer account and sends the credit to the employees' HSAs at Patelco) each month. This automatic set-up is a convenience to the employer each month.

The Employer must provide the following essentials to the Bank:

• Patelco Routing Number: 321076470
• Account Number Range: 746000 (prefix)-6 digit H.S.A number-80 (suffix); so if the employee's account number is 123456, the full number range should read as 74600012345680.
• Account Type: Checking

Patelco Credit Union Branches
For a complete list of branches, please visit www.patelco.org/branches and look under Locations.

Online
You can contribute to your employees' HSAs by transferring funds from your Patelco Membership H.S.A. Employer Funding Account. To open an Employer Funding Account, click here.

Send the completely filled out application form and attach the following information to Patelco Credit Union, attention: Account Manager, 156 Second Street, San Francisco, CA 94105.

• Articles of Incorporation
• Company Bylaws
• List of officers
• Proof of Tax Identification Number or Employer Identification Number
• Copies of valid photo identification cards of all authorized signers
• Signed Board of Corporate Resolution that authorizes the opening of the H.S.A. Employer Funding Account at Patelco Credit Union and designates the authorized signers on the account.

Upon approval, you or your designate will be able to populate the online banking form with your employees' names, account numbers and the contribution funds.

The Online method allows you the control, convenience, ease and flexibility. Your monthly statement will reflect a record of your contributions to your employees' accounts.

Employer Forms
HR Professionals can access the following forms at www.patelco.org.

• Health Savings Account Membership Application and Eligibility form (required)
• HSA Employer Contribution Form (required)
• HSA Transfer Request (optional)
• Health Savings Account Designation of Beneficiaries (required)

For other HSA forms and documents, go to www.patelco.org/forms and you’ll see a list of all Health Savings Account forms.

Send completed paper forms (must be signed and dated where indicated on the forms) to Patelco Credit Union, HSA Department #25, 156 Second Street, San Francisco, CA 94105.

To view the current HSA rates on the Patelco Credit Union web site, click here.