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Health Savings Account Online Enrollment

Thank you for choosing Citizens National Bank for your HSA needs. You may want to print this page and use it as a guide as you fill out the application.


Before you begin the application process, please be sure you have the following items:

  • drivers license number or state ID number, issue and expiration dates
  • social security number
  • names and social security numbers of beneficiaries
Online Application Instructions
  1. The first page will ask for your zip code. Type it in and click continue.
  2. The second page is Citizens National Bank's privacy statement. Please read it carefully and then click continue. You may also print a copy of this for your records.
  3. The application will require you to fill in your personal information including name, social security number, address, etc...
  4. You will then need to specify the type of HSA you wish to open, whether individual or family. There are different deductibility requirements for each and also different maximum amounts you may contribute annually. If you are uncertain, please review the IRS information and review your options.
  5. You will then need to specify what type of statement you would like. We recommend electronic statements as they are updated monthly and you may view it at any time within online banking. If you choose a paper statement, you will receive it monthly with a $5.00 service charge.
  6. You will then need to specify the amount of your initial deposit, if any. You are not required to make an initial deposit to open the account. If you choose to, you will need to mail a check for that amount with the paperwork you will receive after submitting this online application.
  7. You will then need to decide what tax year you would like this amount credited to. HSAs are similar to IRAs in that you may contribute to them up until April 15 of each year and use it as the preceding year's deduction. Consult your tax advisor if you have questions.
  8. You will then need to designate the type of initial deposit you are making. This is where you may indicate if you are rolling over funds from an existing HSA, IRA or Archer MSA. If you are not rolling or transferring funds from another type of account, choose regular from the drop down menu.
  9. You will then need to complete the beneficiary information portion of the application. You will need to determine the percentage each of them is entitled to and whether they are a primary or contingent beneficiary.
  10. You will then have some choices regarding how you access your HSA. You may choose to obtain a Visa® checkcard and/or order checks. You may also indicate if you would like to be able to view your account online through online banking.
  11. Next, you will need to indicate if you would like to establish a power of attorney for this account and, if so, complete that information.
  12. Finally, the terms of the HSA are presented. Please read them completely before clicking the submit button.
Once the application is submitted, we will complete the application process. Expect an email containing directions for electronically signing your application using Docusign.
Additional Information

After your application is processed we will send you a confirmation letter containing your HSA checking account number.

If you requested a debit card and/or checks for this account, they will be mailed to you within 2-3 weeks from the date we receive your electronically signed application. If you requested access to this account online, sign up instructions will be sent to you.