Please note: 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.

Apply Online:

The fastest and easiest way to apply is to Apply Online.  In order to Apply Online for any plan with Golden Rule Insurance Company, you will need to run an instant quote.  When you see the plan you would like to apply for, simply click the APPLY button next to the quote and you will enter the online application process.  

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

For security, Golden Rule uses VeriSign certified SSL 128 bit encryption.

Apply by Fax or Mail:

To apply via fax or mail for any plan with Golden Rule Insurance Company, just follow the instructions below:

Simply run an instant quote, then click "Apply" next to the plan you are interested in and select "download an 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.  Follow the instructions on the first page and complete the entire application.

Please fill out the application completely and include all pages.  Any unanswered questions will delay the processing.  If you have any questions about filling out the application, call application processing department at 866-749-2039, or 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.

Fax your application toll-free to 1-866-284-0082.  Or Mail it to:

HSA for America
1001-A East Harmony Road, #519
Fort Collins, CO 80525

Important:  Golden Rule will charge your first month’s premium immediately upon approval of the application.

Note:  After receiving your policy or certificate, 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.