Health Spending Account (HSA) Forms

Please Note: An HSA is a negotiated agreement between an employer and a specific employee group. Not all school jurisdictions have one. If you are unsure whether or not you have an HSA, contact your employer.

Expense Reimbursement

If you have not yet completed and returned your HSA Enrolment Form to ASEBP, you must do so before ASEBP can process your HSA expense reimbursement request.

Online HSA Expense Submission
Did you know that you can submit your HSA expense reimbursement request online using My ASEBP? Help ASEBP in its efforts to go green by reducing the amount of paper that we process. Log in to My ASEBP and submit your HSA expenses now! If you have not registered for an online account, click here to register.

Paper Submission
If you do decide to submit your HSA expenses using a paper form, download the form using the link in the left menu. *** Read carefully the HSA Expense Reimbursement Requirements that appear on the back of the form before completing.

Automatic Direct Deposit Form

All Health Spending Account (HSA) payments will be made by direct deposit. This is a convenient way to receive your HSA payment by having it deposited directly into your bank account.

You must complete the Automatic Direct Deposit form and ASEBP must receive it before you will receive any payments from your HSA.

NOTE: As an added feature for HSA customers, any payment due to you for ASEBP claims submitted under your ASEBP benefit plan will also be reimbursed by direct deposit rather than by cheque.

If your banking information changes, please complete a new form and send it to ASEBP.