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Benefits

Forms

ELECTRONIC FORMS: Simply click on the navigation link listed for the form you’re needing. When the form comes up on your computer, simply fill in the requested fields. Once complete, click the ”Send” button at the bottom of the form.

For Questions about your Benefits Plans, other than your Health Savings Account (HSA), please contact:

LBG Advisors_Logo.pngPhone: (425) 778-2800 | Toll-Free: (877) 485-2120

PDF "Fillable" Forms

NOTE: Please download the PDF forms to your computer before filling them out. Please be sure to follow the instructions listed on the form. Please “Type ” your information into the form, making sure to complete each section in its entirety. Print, sign, date and U.S. Mail to UMB Bank, P.O. Box 540606, Waltham, MA 02454 or scan/email your completed form to hsasupport@myumbhsa.com. By doing so, you will ensure your submission is processed correctly and in a timely manner.