How to Apply

Please note that all applications will be submitted in the name of Wiley Long, the president of HSA for America.  If you have already been working directly with one of our advisors, then that person will be noted in our system as your personal contact.

Before you apply, be sure to view the CelticSaver HSA brochure.  It contains important information regarding benefits, exclusions, limitations, renewability, and other terms of coverage.

The fastest and easiest way to get your coverage in force is to Apply Online, using one of the links below.  Gather the following information before you start the application in order to speed the process:

1. Your doctors’ names, addresses, and phone numbers
2. Medications you currently take or recently took, including dosage and frequency
3. Dates of hospitalization
4. The name of the plan for which you are applying
5. Your requested effective date
6. Your credit card information to cover the initial premium

Please note:  When Applying Online, Celtic's $25 application fee is waived.  There is a $25 application fee when applying by mail.

To Apply by Mail

1. Select your state below to view the correct PDF application.  When the Adobe Acrobat reader opens with the application, use the menu bar at the top to save the application to a file or simply print it out right from the reader.  (You may also fill out our Application Request Form and we will send you an application right away.)
   
   

   AVAILABLE STATES Alabama Illinois Montana South Carolina Arizona Indiana Nebraska - Arkansas Iowa North Carolina Tennessee Colorado Kansas Ohio Texas Connecticut Louisiana Oklahoma Wisconsin Florida Michigan Pennsylvania -Wyoming Georgia Missouri - -

   
   
2. Simply follow the instructions on the application.  Fax the completed application to us toll free at 1-866-284-0082, or mail it to us at the address below.

Please fill out the application Completely.  Any unanswered questions will delay the processing.  If you have any questions about filling out the application, email us at info@HSAforAmerica.com, leave your name and phone number, and someone from our office will call you back and answer any application questions you have.

Note:  All policies come with a money-back guarantee.  After receiving your policy, you have 10 days to review it.  If for any reason you decide not to keep the policy, you will receive a full refund of your initial premium.  Remember that you also have access to the guaranteed lowest life insurance rates available, with easy online quotes and applications.