Time Applications

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.

The Time HSA Application PDF Adobe Acrobat Reader Information below is for all plans and only differs by state.  Please select your state to view the correct application.  Simply follow the instructions on the application:

 

AVAILABLE STATES
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NOTE:  If you are applying for Preferred Rates, please also submit the Preferred Rating Questionnaire Adobe Acrobat Reader Information with your application.

 

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