One-Time Lump Sum HSA Authorization Form
Purpose
The one-time lump sum contribution option helps to maximize tax-advantaged savings early in the year, provides immediate funds to cover health plan costs and allows for faster investment growth.
Reminders
If the form is submitted by the 10th of the month, it will be effective for that month's pay cycle. Otherwise, it will take effect the following month.
Lump sum contribution amounts do not carry forward in the annual elected pledge amount, please be sure to update annual pledge amounts during the HSA Open Enrollment period late Fall.
Last updated: 2/2026
