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Health Savings Account Online Enrollment

Thank you for choosing Citizens National Bank for your HSA needs. You may want to print this page and use it as a guide as you fill out the application.

Requirements:

Before you begin the application process, please be sure you have the following items:
  • Drivers license number or state ID number
  • Social Security number
  • Names and social security numbers of beneficiaries

Online Application Instructions:

  1. The first page will ask for your zip code. Type it in and click continue.
  2. The second page is CNB's privacy statement. Please read it carefully and then click continue. You may also print a copy of this for your records.
  3. The application will require you to fill in your personal information including name, social security number, address, etc...
  4. You will then need to specify the type of HSA you wish to open, whether individual or family. There are different deductibility requirements for each and also different maximum amounts you may contribute annually. If you're uncertain, please review the IRS info and review your options.
  5. You will then need to specify what type of statement you'd like. You will receive statements quarterly at a minimum if you prefer to receive them in the mail. If you opt for an electronic statement, you will receive it monthly.
  6. You will then need to specify the amount of your initial deposit, if any. You are not required to make an initial deposit to open the account. If you choose to, you'll need to mail a check for that amount with the paperwork you'll receive after submitting this online application.
  7. You'll then need to decide what tax year you'd like this amount credited to. HSAs are similar to IRAs in that you may contribute to them up until April 15 of each year and use it as the preceding year's deduction. Consult your tax advisor if you have questions.
  8. You'll then need to designate the type of initial deposit you're making. This is where you may indicate if you're rolling over funds from an existing HSA, IRA or Archer MSA. If you're not rolling or transferring funds from another type of account, choose regular from the drop down menu.
  9. You'll then need to complete the beneficiary information portion of the application. You'll need to determine the percentage each of them is entitled to and whether they're a primary or contingent beneficiary.
  10. You'll then have some choices regarding how you access your HSA. You may choose to obtain a VISA checkcard and/or order checks. You may also indicate if you'd like to be able to view your account online through Online Banking.
  11. Next, you'll need to indicate if you'd like to establish a power of attorney for this account and, if so, complete that information.
  12. Finally, the terms of the HSA are presented. Please read them completely before clicking the submit button.

Once the application is submitted, we will complete the application process. You'll be required to return the following to us in the provided prepaid envelope:

  • Paperwork will be sent back to you for you to sign.
  • A copy of your drivers license or state ID.
  • Enrollment fee: $25. Make check payable to Citizens National Bank.
  • Initial Deposit: If you would like to make an initial deposit, send a separate check for that amount. Make check payable to Citizens National Bank.

Additional Information

  • After your account paperwork is received and processed we will send you a confirmation letter containing your HSA Checking Account number along with a confirmation of the deposit received.
  • If you requested a debit card and/or checks for this account, they will be mailed to you within 2-3 weeks from the date we receive your signed new account paperwork. If you requested access to this account online, sign up instructions will be mailed to you.
apply for an hsa

Need assistance?

Email us at hsa@cnbohio.com or phone any of our branch locations during regular business hours.