The Inspira HSA transfer form authorizes a direct, trustee-to-trustee move of health savings account funds from another custodian into your Inspira account. You download it from your Inspira member portal, complete four short sections, sign it, and send it back by mail or fax. Because the money moves directly between custodians and never passes through your hands, the transfer stays tax-free and does not count against your annual contribution limit.
Where to Download the Form
Log in at inspirafinancial.com. From your dashboard, open your health savings account and select “Transfer your other HSA funds” to pull up the PDF. You can also click “Documents & Forms,” then “Health Savings Account Forms,” and choose the HSA Trustee Transfer Form.1Inspira Financial. HSA Transfer Flyer Inspira was previously known as PayFlex and Millennium Trust, so older paperwork and employer materials may still reference those names.2Inspira Financial. About Inspira Financial
Before you sit down with the form, pull together your current HSA custodian’s legal name, mailing address, and your account number with them, along with your Inspira HSA account number from your dashboard or a recent statement. You will need a wet or electronic signature on the certification line, so plan to print or sign digitally at the end.
How to Fill Out Each Section
The form has four sections plus a signature block.
Section 1: HSA Account Owner Information
Enter your full legal name, Social Security number, street address (no PO boxes), email, and daytime phone number.3Inspira Financial. Health Savings Account (HSA) Transfer Request Form The name here must match the name on your existing HSA exactly. If there is a mismatch, for instance after a marriage or legal name change, call your current custodian first. Some will ask you to update your records with them before releasing funds; others require a “one-and-the-same” letter tying the two names together.
Section 2: Type of Transfer
Check one of three boxes:3Inspira Financial. Health Savings Account (HSA) Transfer Request Form
- HSA to HSA Transfer, for moving funds from another health savings account. This is the common case.
- Archer MSA to HSA Transfer, if you still hold an older Archer Medical Savings Account.
- IRA to HSA Transfer, a one-time qualified funding distribution from a traditional or Roth IRA. The IRS caps this at your annual HSA contribution limit for the year, and you can only do it once in your lifetime.
Section 3: Transfer Instructions
Here you identify where the money is coming from and how much to move. Fill in your current custodian’s full legal name, their mailing address, and your account number with them. Verify that account number against a recent statement; a single wrong digit can stall the transfer for weeks.
Then pick one of two options. “Entire Account Balance” tells the current custodian to liquidate everything and send the full amount, which typically closes the old account and may trigger a closure fee. Choosing a specific dollar amount keeps the old account open, though some custodians require a minimum balance to stay open. HealthEquity, for example, requires at least $25.3Inspira Financial. Health Savings Account (HSA) Transfer Request Form
Section 4: Inspira HSA Information
Section 4 is pre-printed with Inspira’s mailing address and contact details, which your old custodian uses to send the funds. You generally do not need to fill anything in here. If the form prompts you to confirm your Inspira account number, double-check that it appears correctly.
Certification and Signature
Sign and date the form at the bottom. Inspira does not require a notary or medallion signature guarantee. Your current custodian may have its own signature requirements before it will release funds, so if you are moving a large balance, call and ask before you submit.
If Your Old HSA Holds Investments
Most HSA custodians transfer only cash, not securities. If your old account holds mutual funds, stocks, or other investments, the custodian will usually require those holdings to be sold and the proceeds swept back into the HSA cash balance before the transfer goes through. Some custodians handle the liquidation for you; others expect you to log in and sell the positions yourself. Either way, confirm that the proceeds land in the HSA cash balance rather than being paid out to you, because a distribution to you personally could create a taxable event.
In-kind transfers, where the securities move without being sold, are technically possible but depend on both custodians supporting them. Most HSA providers do not. If unrealized gains or market timing matter to you, call both Inspira and your current custodian before you submit the form to ask whether an in-kind transfer is available.
How to Submit the Form
Once the form is filled out and signed, you have two options:
- Mail it to Inspira Financial, PO Box 2495, Omaha, NE 68103. For overnight delivery, use the street address at 11819 Miami St., Suite 200, Omaha, NE 68164. Certified mail with tracking is worth the small cost on a significant balance.4State of Alaska Division of Retirement and Benefits. Inspira Reimbursement Account Quick Reference Guide5Inspira Financial. Contact Us
- Fax the form using the number printed at the bottom of the PDF. The transmission confirmation page serves as your proof of delivery.
For some straightforward HSA-to-HSA moves, Inspira’s website and app support an electronic transfer that skips the paper form entirely.6Inspira Financial. Contact and Support for Individuals Log in and check whether that option appears for your account before printing anything. Whichever route you take, keep a copy of the signed form and your delivery confirmation. If processing hits a snag, that documentation saves time.
Timeline and Tracking
Expect three to five weeks from the day Inspira receives your form. The biggest variable is your old custodian’s processing speed; Inspira cannot force another institution to move faster. Once the old custodian mails the check to Inspira, the funds typically post within five business days of receipt.7Inspira Financial. Aim for Efficiency by Combining Your HSAs
Watch your Inspira dashboard for status changes. If nothing has moved after four weeks, call your old custodian first, because that is almost always where delays originate. Common causes are an account number mismatch, an unsigned form, a name discrepancy between the two accounts, or invested funds that were never fully liquidated to cash. A single phone call usually clears it.
Fees on Both Sides
Inspira does not charge an incoming transfer fee when funds move into your Inspira HSA from another custodian. Inspira does charge a $25 account closure fee, but that applies when you move funds out of Inspira, not in.8Inspira Financial. Health Savings Account (HSA) Fee Schedule
Your current custodian may charge its own outbound transfer or closure fee. These vary, but around $25 is typical. Optum Bank, for instance, charges $25 to transfer out.9Optum Bank. Health Savings Account Enrollment Check the fee schedule before you initiate the transfer. On a full transfer, the custodian usually deducts the fee from your balance before mailing the check.
Why This Form Is Better Than a Rollover
The Inspira transfer form uses a direct trustee-to-trustee transfer. The money moves from one custodian to the other without passing through you. The IRS does not treat it as a distribution, so it is not reported on Form 1099-SA and does not appear on your Form 8889.10Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans Custodians are explicitly instructed not to report these on Form 1099-SA or Form 5498-SA.11Internal Revenue Service. Instructions for Forms 1099-SA and 5498-SA If your old custodian issues a 1099-SA in error, contact them right away to have it corrected. You can do as many direct transfers in a year as you want.
A 60-day rollover is a different animal. Your old custodian sends a check payable to you, and you have 60 days from receipt to deposit it into another HSA. Miss the window and the entire amount becomes taxable income, plus a 20 percent additional tax on top of your regular rate.12Office of the Law Revision Counsel. 26 USC 223 – Health Savings Accounts The 20 percent penalty does not apply if you are 65 or older or disabled, but the amount still counts as taxable income. You are also limited to one rollover per 12-month period across all your HSAs, with the clock starting on the date you receive the distribution.10Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans Given the risk and the limits, the direct transfer on the Inspira form is almost always the better choice, unless your old custodian refuses to process a trustee-to-trustee transfer.