Member Forms

Member Forms

Employer Forms

Enrollment Spreadsheets: Please choose the appropriate spreadsheet for your plan design. Complete and upload to our Secure Upload.

Employer Forms

Enrollment Spreadsheets: Please choose the appropriate spreadsheet for your plan design. Complete and upload to our Secure Upload.

Termination Form

Please complete the following termination form for any employees who need their plans terminated. The secure form will be sent to the eligibility department for processing and a confirmation will be emailed when completed.

Termination Form

Termination Form

Please complete the following termination form for any employees who need their plans terminated. The secure form will be sent to the eligibility department for processing and a confirmation will be emailed when completed.

Termination Form

Video Resources

Video Resources

Employer Portal: Accessing Benefit Account Reports
FSA Rollover Guide
Employer Portal: Navigating the Employer Portal
Employer Portal: Uploading HSA Contributions

Health Savings Account Contribution Limits & Deductible Minimums

HSA 2025 2026
Single Contribution Limit $4,300 $4,400
Family Contribution Limit $8,550 $8,750
Single Minimum Deductible $1,650 $1,700
Family Minimum Deductible $3,300 $3,400

FAQ's

  • How do I use my card?

    You can use your card at the point of sale, just like any other card. There is no pin number associated, so make sure to always choose credit. Please keep in mind that the ability to use your card at certain providers is determined by your plan design and will differ from company to company and even among you and your co-workers. Please review your employee plan details to determine where your card can be used.

  • Why do I need to provide documentation?

    Due to the tax savings nature of the Healthy Dollars plans, you may be asked for documentation to verify dates of service and the eligibility of your item per your plan design and/or IRS requirements

  • How do I create an account online?

    Online and Mobile access is provided to you and allows you a secure system to review account balances, transactions, upload claims and documentation requests, and to update your direct deposit information. Go to the “Login to Member Portal” link on this page and you will be directed to set up an account. Due to the sensitive nature of your private health information, our site is secure, and your information will not be provided to your employer.

  • How do I submit a claim?

    If you are unable to use your card, you can submit a manual claim to us for reimbursement. First, create an account online and make sure that your direct deposit information is updated. Second, you can submit the claim online or via email with a manual claim form from the website to claims@healthydollarsinc.com.

  • How do I contact Healthy Dollars?

    Our LIVE customer service team is available Monday – Thursday 8 am – 6 pm and Friday until

    5 pm (EST). You can also reach us via email at service@healthydollarsinc.com