You can count on us to keep your data secure
We take the protection of your employees’ personal information very seriously. That’s why we’ve implemented state-of-the-art electronic security systems and certifications that exceed industry standards.
HIPAA/HITECH Compliance
Ameriflex maintains a comprehensive HIPAA Privacy/Security Policy and an FTC Red Flags policy. Ameriflex uses an internal HIPAA committee led by a corporate HIPAA Privacy/Security officer. Additionally, every department that comes in contact with protected health information (PHI) maintains department-level procedures that are updated on a regular basis. All employees are trained and evaluated in part based upon compliance with HIPAA and Ameriflex security policies. All infrastructure, facilities and computer systems are governed by our HIPAA security procedures.
We take this commitment to HIPAA compliance a step further by contracting with an outside firm to perform a HIPAA audit every two years. The auditors provide an accurate and thorough assessment of any potential risks and vulnerabilities by examining our business processes, systems infrastructure, and access control. The auditors also perform vulnerability scans on external-facing and select internal infrastructure devices and servers in order to determine high-risk vulnerabilities, as well as operational details such as patch levels, configuration errors, and filtering rules. While the law does not require this audit, we have made it standard protocol so as to ensure that we are truly maintaining the highest data integrity levels possible.
Hosting Site Security
We maintain multiple hosting sites, both on-location with redundant backups between our Texas and New Jersey operations centers (with automatic failover), and off-location at geographically diverse data centers that exceed Department of Defense (DoD) standards for a Sensitive Compartmented Information Facility (SCIF). The security and reliability features of our data centers and network provider are too numerous to list; however, we boast 99.99%+ uptime. Ameriflex and all its subcontractors are SAS 70 or SSAE 16 (SOC1) Type II reviewed. All data transmitted to our self-service systems is done using PGP with customizable password and CAPTCHA requirements on a client-by-client basis.
Personnel Security
Ameriflex employees undergo PHI and HIPAA training during their onboarding process. They are also instructed on a comprehensive visitor security policy at each facility location, as well as clean desk and computer workstation security policies.
Disaster Recovery
Ameriflex has redundant operating centers in Texas and New Jersey, along with automatic database replication and system failover in the event that one site temporarily goes down. Critical systems and databases are not only replicated multiple times per day between the two operating centers, but they are also backed up and hosted in off-site datacenters. We run continuous database backups and store encrypted copies off-site per our SSAE 16 control list. We have a disaster recovery plan that takes advantage of our infrastructure and allows us to service clients from either of our operating centers; in addition, with the redundancies built into our systems and datacenters, clients can continue to self-service in the event of an outage at an office location.
Your privacy is very important to us. Accordingly, we have developed this Policy in order for you to understand how we collect, use, communicate and disclose and make use of personal information.
The following outlines our privacy policy:
We are committed to conducting our business in accordance with these principles in order to ensure that the confidentiality of personal information is protected and maintained.
The information sharing practices described above are in accordance with federal law. California and Vermont, and various other state law places additional restrictions on sharing information about their residents, and our policies comply with such restrictions.
Some states, including California, permit you to request certain information regarding disclosure of personal information to third parties for their direct marketing purposes. To make such a request, please send an e-mail to legal@myameriflex.com.
Cal. Bus. And Prof. Code Section 22575 also require us to notify you how we deal with the “Do Not Track” settings in your browser.
This California Privacy Policy applies only to California consumers (“you” or collectively as “consumers”). The California Consumer Privacy Act of 2018 (“CCPA”) and the California Privacy Rights Act of 2020 (“CPRA”), collectively referred to as “California Consumer Privacy Laws”, provide California consumers with specific rights regarding their personal information.
Yes, if you are a resident of California, you are granted specific rights regarding access to your personal information.
California Civil Code Section 179883, also known as the “Shine The Light” law, permits our users who are California residents to request and obtain from us, once a year and free of charge, information about categories of personal information (if any) we disclosed to third parties for direct marketing purposes and the names and addresses of all third parties with which we shared personal information in the immediately preceding calendar year If you are a California resident and would like to make such a request, please submit your request in writing to us using the contact information provided below.
On January 1, 2020, the California Consumer Privacy Act of 2018 (CCPA) took effect and sets new requirements and rights relating to personal information of California consumers. This section for California residents applies solely to visitors, users, and others who reside in the State of California (“consumers” or “you”). We adopt this notice to comply with the California Consumer Privacy Act of 2018 (“CCPA”) and other California privacy laws. Any terms defined in the CCPA have the same meaning when used in this notice.
Information We Collect
We collect information that identifies, relates to, describes, references, is capable of being associated with, or could reasonably be linked, directly or indirectly, with a particular consumer or device (“personal information”). In particular, we have collected the following categories of personal information from consumers within the last twelve (12) months:
| Category | Examples | Collected |
| A. Identifiers. | A real name, alias, postal address, unique personal identifier, online identifier, Internet Protocol address, email address, account name, Social Security number, driver’s license number, passport number, or other similar identifiers. | Yes |
| B. Personal information categories listed in the California Customer Records statute (Cal. Civ. Code § 1798.80(e)). | A name, signature, Social Security number, physical characteristics or description, address, telephone number, passport number, driver’s license or state identification card number, insurance policy number, education, employment, employment history, bank account number, credit card number, debit card number, or any other financial information, medical information, or health insurance information. Some personal information included in this category may overlap with other categories. | Yes |
| C. Protected classification characteristics under California or federal law. | Age (40 years or older), race, color, ancestry, national origin, citizenship, religion or creed, marital status, medical condition, physical or mental disability, sex (including gender, gender identity, gender expression, pregnancy or childbirth and related medical conditions), sexual orientation, veteran or military status, genetic information (including familial genetic information). | Yes |
| D. Commercial information. | Records of personal property, products or services purchased, obtained, or considered, or other purchasing or consuming histories or tendencies. | Yes |
| E. Biometric information. | Genetic, physiological, behavioral, and biological characteristics, or activity patterns used to extract a template or other identifier or identifying information, such as, fingerprints, faceprints, and voiceprints, iris or retina scans, keystroke, gait, or other physical patterns, and sleep, health, or exercise data. | Yes |
| F. Internet or other similar network activity. | Browsing history, search history, information on a consumer’s interaction with a website, application, or advertisement. | Yes |
| G. Geolocation data. | Physical location or movements. | Yes |
| H. Sensory data. | Audio, electronic, visual, thermal, olfactory, or similar information. | Yes |
| I. Professional or employment-related information. | Current or past job history or performance evaluations. | Yes |
| J. Non-public education information (per the Family Educational Rights and Privacy Act (20 U.S.C. Section 1232g, 34 C.F.R. Part 99)). | Education records directly related to a student maintained by an educational institution or party acting on its behalf, such as grades, transcripts, class lists, student schedules, student identification codes, student financial information, or student disciplinary records. | Yes |
| K. Inferences drawn from other personal information. | Profile reflecting a person’s preferences, characteristics, psychological trends, predispositions, behavior, attitudes, intelligence, abilities, and aptitudes. | Yes |
| L. Sensitive Personal Information | Yes |
We will use and retain the collected personal information as needed to provide the Services or for:
Category A – As long as the user has an account with us
Category B – As long as the user has an account with us
Category G – As long as the user has an account with us
We may also collect other personal information outside of these categories through instances where you interact with us in person, online, or by phone or mail in the context of:
The Services are hosted and operated in the United States (“U.S.”) through and its service providers, and if you do not reside in the U.S., laws in the U.S. may differ from the laws where you reside. By using the Services, you acknowledge that any Personal Data about you, regardless of whether provided by you or obtained from a third party, is being provided in the U.S. and will be hosted on U.S. servers, and you authorize Ameriflex to transfer, store and process your information to and in the U.S., and possibly other countries.
Your Right to Correction. You have the right to request the correction of any inaccurate personal information that we maintain about you, taking into account the nature of the personal information and the purposes of the processing of the personal information. We will use commercially reasonable efforts to correct the inaccurate personal information as you may direct.
To help protect the privacy of data and personally identifiable information you transmit through use of this site and any other related services, we maintain physical, technical and administrative safeguards. We update and test our security technology on an ongoing basis. We restrict access to your personal data to those employees who need to know that information to provide benefits or services to you. In addition, we train our employees about the importance of confidentiality and maintaining the privacy and security of your information. We commit to taking appropriate disciplinary measures to enforce our employees’ privacy responsibilities.
The CCPA information we collect comes directly from you when you inquire about our products and services via our website or by telephone or when you file a claim for reimbursement or view our website; from your employer (where applicable) where your employer is providing benefits; and from third parties that assist us in providing these benefits.
We may use or disclose the personal information listed above for the following purposes, as permitted by CCPA and other applicable law:
We do not sell your CCPA information.
In the future, where the CCPA applies to the product or service we offer, you may have the right to request access, data portability, and deletion rights.
We will not discriminate against you for exercising your CCPA rights.
We reserve the right to amend our Privacy Policy or this privacy notice at our discretion and at any time.
You may be able to request this notice in another language where we provide such notices in the ordinary course of business or in an alternative format if you have a disability. Please see our contact information below to request an alternative format.
If you have any questions or comments about this notice, our Privacy Policy, the ways in which we collect and use your information, your choices and rights regarding such use, or wish to exercise your rights under California law, please do not hesitate to contact us at:
Ameriflex
Attn: General Counsel
2508 Highlander Way, Suite 200
Carrollton, TX 75006
Or
legal@myameriflex.com
1. Terms
By accessing this website, you are agreeing to be bound by these website Terms and Conditions of Use, all applicable laws and regulations, and agree that you are responsible for compliance with any applicable local laws. If you do not agree with any of these terms, you are prohibited from using or accessing this site. The materials contained in this website are protected by applicable copyright and trademark law.
2. User License
Permission is granted to temporarily download one copy of the materials (information or software) on Ameriflex’s website for personal, non-commercial transitory viewing only. This is the grant of a license, not a transfer of title, and under this license you may not:
3. Disclaimer
The materials on Ameriflex’s website are provided “as is”. Ameriflex makes no warranties, expressed or implied, and hereby disclaims and negates all other warranties, including without limitation, implied warranties or conditions of merchantability, fitness for a particular purpose, or non-infringement of intellectual property or other violation of rights. Further, Ameriflex does not warrant or make any representations concerning the accuracy, likely results, or reliability of the use of the materials on its Internet website or otherwise relating to such materials or on any sites linked to this site.
4. Limitations
In no event shall Ameriflex or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use or inability to use the materials on Ameriflex’s Internet site, even if Ameriflex or a Ameriflex authorized representative has been notified orally or in writing of the possibility of such damage. Because some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages, these limitations may not apply to you.
5. Revisions and Errata
The materials appearing on Ameriflex’s website could include technical, typographical, or photographic errors. Ameriflex does not warrant that any of the materials on its website are accurate, complete, or current. Ameriflex may make changes to the materials contained on its website at any time without notice. Ameriflex does not, however, make any commitment to update the materials.
6. Links
Ameriflex has not reviewed all of the sites linked to its Internet website and is not responsible for the contents of any such linked site. The inclusion of any link does not imply endorsement by Ameriflex of the site. Use of any such linked website is at the user’s own risk.
7. Site Terms of Use Modifications
Ameriflex may revise these terms of use for its website at any time without notice. By using this website you are agreeing to be bound by the then current version of these Terms and Conditions of Use.
8. Governing Law
Any claim relating to Ameriflex’s website shall be governed by the laws of the State of Texas without regard to its conflict of law provisions.
The Account Owner named (“Account Owner,” and also referred to herein using pronouns such as “you” and “your”) is establishing this Health Savings Account (“HSA” or “Custodial Account” or the “Account”) exclusively for the purpose of paying or reimbursing Qualified Medical Expenses of the Account Owner, his or her spouse, and Dependents. The Account is being opened by Acressa Insurance, Inc. (“Custodian,” and also referred to herein using pronouns such as “we,” “us” and “our”). The Account Owner has assigned to this Custodial Account the funds described related to their Health Savings Account. For married persons, each spouse who is eligible to open an HSA and wants to contribute to an HSA must establish his or her own account. The identifying number for an HSA will be the Account Owner’s individual HSA account number.
As Custodian for the Account, we will cause the Account Owner’s funds to be placed into a deposit account (the “Deposit Account”) at a depository institution (the “Depository”) selected by us in our sole discretion. Depository is UMB Bank. You will receive periodic Account statements that will reflect your ownership of your HSA funds held in the Deposit Account. You should retain the Account statement(s) for your records.
While we are acting as Custodian for your Account, all contributions to your HSA (made by you, your employer, a family member or any other person) will be made to us, and we will cause the funds to be deposited to the Deposit Account. We will cause funds to be disbursed from the Deposit Account pursuant to this Health Savings Account Custodial Agreement (as defined below), the “Agreement”.
You may not transfer the Deposit Account directly to another depository institution.
At your election, you may dismiss us as Custodian in accordance with Article XII, below, and appoint a successor custodian or trustee authorized to act as such in relation to HSAs under the Code. As soon as is practicable following written notice of the appointment of such a successor custodian or trustee, we will cause the funds in the Deposit Account to be transferred to the successor custodian or trustee.
The Account Owner represents that, unless this Account is used solely to make Rollover or Transfer Contributions as defined below, he or she is eligible to contribute to this HSA; specifically, that he or she: (1) is covered under a High Deductible Health Plan (“HDHP”); (2) is not also covered by any other health plan that is not an HDHP (with certain exceptions described herein for plans providing preventive care and limited types of permitted insurance and permitted coverage); (3) is not enrolled in Medicare; and (4) cannot be claimed as a Dependent on another person’s tax return. Custodian has no obligation to verify that any applicant for an Account is eligible to establish an HSA under applicable laws and regulations.
IRS Form 5305-C, on which this section of the Health Savings Account Custodial Agreement is based, is a model custodial account agreement that has been approved by the IRS, with permissible additional provisions that may be agreed to between Custodian and Account Owner. The model agreement provisions provided by the IRS as well as the additional provisions added by Custodian are contained within this Agreement. Also, further provisions applicable to the HSA, including certain disclosures required by various banking laws and regulations, are contained here. An HSA is established subject to the acknowledgment of this Agreement. The Account Owner may acknowledge this Agreement any time during the tax year. An HSA must be created in the United States for the exclusive benefit of the Account Owner.
Do not file Form 5305-C or any part of this Agreement with the IRS. Instead, keep the Agreement with your records.
For more information on HSAs, see Notice 2004-2, 2004-2 I.R.B. 269, Notice 2004-50, 2004-33 I.R.B. 196, Pub. 969, Health Savings Accounts and Other Tax-Favored Health Plans, and other IRS published guidance.
Certain terms used in this Agreement, which are not defined elsewhere herein, shall have the following meanings:
The Account Owner and Custodian make the following Agreement:
It is the responsibility of the Account Owner to determine whether contributions to this HSA have exceeded the maximum annual contribution limit described in Article II. If contributions to this HSA exceed the maximum annual contribution limit, the Account Owner shall notify Custodian that there exist excess contributions to the HSA. It is the responsibility of the Account Owner to request the withdrawal of the excess contributions and any net income attributable to such excess contributions.
The Account Owner’s interest in the balance in this custodial account is non-forfeitable. ARTICLE V
If the Account Owner dies before the entire interest in the Account is distributed, the entire Account will be disposed of as follows:
Notwithstanding any other Article that may be added or incorporated in this Agreement, the provisions of Articles I through VIII and this sentence are controlling. Any additional Article or provision in this Agreement that is inconsistent with Section 223 of the Code or IRS published guidance will be void.
This Agreement will be amended from time to time to comply with the provisions of the Code or IRS published guidance. Other amendments may be made in accordance with Article XIV.
Except as hereinafter provided, the Account Owner hereby directs Custodian to invest contributions to the Account in an interest-bearing deposit account with a bank or similar depository institution.
1. Indemnification, Limitation of Liability and Disclaimers
a. The Account Owner hereby releases and agrees to indemnify, defend, and hold harmless Custodian, its parent company, affiliates, and subsidiaries, and their respective directors, officers, employees and agents (collectively, the “Custodian Indemnified Parties”), promptly after receipt of a request therefrom, from and against any and all claims, liabilities, obligations, losses, damages, penalties, actions, judgments, suits, proceedings, costs (including, without limitation, the fees and expenses of legal counsel to the Custodian Indemnified Parties), expenses, or disbursements of any kind or nature whatsoever and by whomsoever brought or caused (collectively, the “Indemnified Liabilities”) that may be imposed upon, incurred by, or asserted against the Custodian Indemnified Parties and that in any way relate to or arise out of: (i) your breach of this Agreement; (ii) your negligence, fraud, intentional misconduct or criminal acts; (iii) any action taken or omitted by Custodian in accordance with instructions or other communications authorized by or on behalf of you or that Custodian has a reasonable, good faith basis to believe to have been so authorized; (iv) any subpoena, order, levy, garnishment, or request related to the Account; or (v) any loss or claim arising from your failure to use or adhere to the Security Procedures.
b. TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, CUSTODIAN’S LIABILITY TO YOU ARISING FROM OR RELATED IN ANY WAY TO THIS AGREEMENT (WHETHER BASED IN CONTRACT, TORT, OR ANY OTHER THEORY OF LIABILITY) SHALL BE LIMITED TO ACTUAL AND PROVEN DAMAGES ARISING DIRECTLY FROM CUSTODIAN’S WILLFUL MISCONDUCT OR GROSS OTHER THAN AS SET FORTH IN THE PREVIOUS SENTENCE OR AS OTHERWISE PROVIDED HEREIN, CUSTODIAN SHALL NOT INCUR ANY LIABILITY OF ANY NATURE IN CONNECTION WITH THE ACCOUNT.
c. THE ACCOUNT, THE WEBSITE, AND ALL RELATED SERVICES AND DOCUMENTATION ARE PROVIDED BY CUSTODIAN ON “AS IS” BASIS, EXCEPT AS EXPRESSLY SET FORTH HEREIN, CUSTODIAN MAKES NOT REPRESENTATIONS OR WARRANTIES OF ANY NATURE WITH RESPECT TO THE ACCOUNT, THE WEBSITE, OR ANY RELATED SERVICES AND DOCUMENTATION, THAT YOUR USE THEREFORE WILL BE ERROR- FREE OR THAT CUSTODIAN’S OPERATIONS WILL BE UNINTERRUPTED. FURTHER, CUSTODIAN HEREBY DISCLAIMS ALL LIABILITY THERETO AND EXPRESSLY DISCLAIMS ANY IMPLIED WARRANTY OF MERCHANTABILITY, FITNESS FOR A SPECIFIC PURPOSE, INFRINGEMENT OR OTHER IMPLIED CONTRACTUAL WARRANTY, AND YOU HEREBY AGREE AND ACKNOWLEDGE THAT CUSTODIAN SHALL HAVE NO LIABILITY TO YOU WHATSOEVER FOR ANY OF THE MATTERS SET FORTH IN THIS SECTION.
2. Change of Address. Account Owner shall notify Custodian of any change of Such change shall be effective upon the receipt of the change of address authorization.
3. Termination by the Account Owner. The Account Owner shall have the right to terminate this Account. The Account Owner shall appoint a successor custodian or trustee authorized to act as such in relation to HSAs under the As soon as is practicable following written notice of this appointment, Custodian shall transfer all assets and appropriate records of the Account to the successor custodian or trustee. Custodian shall not be liable for any actions or failures to act on the part of any successor custodian or trustee, nor for any tax consequences the Account Owner may incur resulting from any transfer or distribution.
4. Termination by Custodian. Custodian may resign and terminate this Agreement at any time upon thirty (30) days written notice to the Account Owner and shall turn over to the successor custodian or trustee all assets and appropriate records of the Custodian shall not be liable for the acts or omissions of any successor custodian or trustee. If the Account Owner does not name a successor custodian or trustee within thirty (30) days after written notice of Custodian’s resignation, Custodian may appoint a successor custodian for the Account. After Custodian has transferred the assets of the Account in connection with the termination of the Account, it shall be relieved of all further liability with respect to the Account.
a. Custodian may resign and terminate this Agreement at any time upon 30 days written notice to the Account Owner and shall turn over to the successor custodian or trustee all assets and appropriate records of the Custodian shall not be liable for the acts or omissions of any successor custodian or trustee. If the Account Owner does not name a successor custodian or trustee within 30 days after written notice of Custodian’s resignation, Custodian may appoint a successor custodian for the Account Owner.
b. Custodian shall have the right, power and authority to do each and every act and thing and to enter into and carry out each and every agreement with respect to the Account which may be necessary or advisable to discharge its responsibilities under this Agreement.
a. Custodian may grant the Account Owner online access to the Account through Custodian’s website (the “Website”). The Website may be made available for view access only or to allow the Account Owner to execute certain other services online. Custodian does not guarantee and is not liable for the performance, security or privacy of the Website or the Account Owner’s ability to access the Website. Custodian may use a third-party service provider to establish, design, maintain and provide access, connectivity and related services through multiple interfaces of the Website. Such interfaces together with the Website shall be controlled by Custodian and remain subject to the terms and conditions of this Agreement and applicable law.
b. Your access to the Website is subject to Custodian’s security procedures, which may include the use of out of band identification codes, multi-factor authentication, unique login identifications, confidential passwords, call back verifications, and dual control procedures (collectively, the “Security Procedures”). Each time Account Owner make access the Website, Account Owner warrants that the Security Procedures are commercially reasonable. We are not under any circumstance liable for the unavailability of access to the Website or data entry errors and other errors made by the Account Owner when using the Website. Custodian may, in its discretion, use additional procedures to verify the authenticity of Account Owner’s access credentials or a request for any services related to the Custodian is not responsible for Account Owner’s refusal to act upon any instruction received by Custodian that does not comply with the Security Procedures, including where Custodian’s reasonable efforts to verify instructions in accordance with the Security Procedures have failed or where action is delayed until such verification can be obtained. Custodian reserves the right to issue new Security Procedures and/or cancel or change any Security Procedure from time to time. Account Owner understands that the Security Procedures are not designed for the detection of errors in the transmission or content from Account Owner to Custodian and that Custodian is not obligated to detect errors, even if it takes action from time to time to do so. No procedure for the detection of errors has been agreed upon between the Account Owner and Custodian, and Account Owner is solely liable for such errors. IN THE EVENT ACCOUNT OWNER DECLINES TO USE OR FAIL TO USE THE SECURITY PROCEDURES AS INSTRUCTED, CUSTODIAN DISCLAIMS ALL LIABILITY FOR ANY RESULTING LOSSES WHICH COULD HAVE BEEN PREVENTED BY YOUR USE OF THE SECURITY PROCEDURES.
2. Privacy. The Account is subject to the privacy and security protections of the Gramm-Leach-Bliley Act. Custodian has policies and procedures in place designed to maintain the confidentiality of the Account Owner’s personal information. Custodian collects, processes, discloses, and safeguards such personal information in accordance with its privacy notice and policy, which can be viewed on the Website. All personal information furnished by Account Owner in connection with the Account is subject to Custodian’s privacy notice and policy. With respect to any data breach or security incident, Custodian will comply with notification requirements and data breach procedures required by state and federal law and as set forth in its privacy notice and policy.
3. Tax Matters. This HSA Custodial Agreement includes and is intended to be the Internal Revenue Service’s model custodial account agreement (IRS Form 5305-C). Certain additions have been made in accordance with Article XI of the model agreement and have been drafted with the intention that they comply with the provisions of Section 223 of the Code and any regulations thereunder. However, the tax consequences of the establishment of an Account under this Agreement, and the contributions to and distributions from the Account, are the responsibility of the Account Owner and the Account Owner’s tax and legal advisors.
4. Successor Custodian. If Custodian reorganizes, mergers with another organization (or comes under the control of any federal or state agency), or if Custodian’s entire business organization or any portion thereof is acquired by another organization, the surviving organization shall automatically become the trustee or custodian under the Code and applicable law (the “Successor Custodian”). Custodian shall provide the Account Owner with notice of any event resulting in a Successor Custodian. If the Owner does not close or complete a transfer of the Account within thirty (30) days from the date of Custodian’s notice, Custodian will transfer the Account assets to the Successor Custodian without further notice.
5. Securities Disclosure. Unless the Account Owner has expressly objected to the disclosure of such information, pursuant to Securities and Exchange Commission Rule 14b-2 promulgated under the Securities Exchange Act of 1934, as amended, Custodian is required to disclose the following information to each issuer of securities held under this Agreement from time to time: the Account Owner’s name, address and holdings of securities of that issuer. To object to and prevent such disclosure under Rule 14b-2, the Account Owner must notify Custodian in writing.
6. Restrictions on Distribution. Notwithstanding Article VI, distribution of funds from the Account may be subject to reasonable restrictions on frequency or minimum amounts established by Custodian and communicated in advance to the Account Owner in the Health Savings Account Deposit Agreement or elsewhere in this Agreement.
7. Mistake. The Account Owner may repay to the Account any amount distributed from the Account because of a mistake of fact due to reasonable cause that an expense paid or reimbursed by the Account was a Qualified Medical Expense, by no later than April 15 of the year following the year in which the Account Owner knew or should have known the distribution was in error. Custodian may rely on the Account Owner’s representation that the distribution was a mistake that qualifies for a return as provided herein.
8. Rollover Contribution. Notwithstanding Article I, Custodian may require the Account Owner to furnish written evidence that any property comprising all or part of any Rollover Contribution qualifies as a “rollover contribution” as defined under Code Section 223 prior to accepting the contribution as a rollover.
9. Notice and Consent to Electronic Disclosures. Any notice provided for in this Agreement shall be effective when Custodian sends it to the Account Owner at the Account Owner’s last known address in Custodian’s records or posts it in electronic form to the Website. The Account Owner consents to and agrees that all notices, disclosures, documentation and other information related to the Account may be made available by Custodian, at Custodian’s discretion, to Account Owner via first class mail or electronically through the Website and/or delivered to the Account Owner via email, and such notices, documentation, and other information related to the Account will be considered delivered when so made available or delivered. Any notice to be given to Custodian must be delivered via first class mail to: Ameriflex, 2508 Highlander Way, Suite 200, Carrollton, TX 75006, and shall be considered effective when Custodian received it. The Account Owner is responsible to advise the Custodian in writing of any change to its email or mailing address of records.
10. Governing Law, Jurisdiction and Venue. This Agreement shall be governed by federal law and regulations, and to the extent applicable, the laws of the State of Arizona, without regards to the conflict of law principles thereof. If for any reason a dispute arises, the Account Owner hereby (i) irrevocably and unconditionally consent to the jurisdiction of the state courts of the State of Arizona located in Maricopa County and the federal courts of the United States of America located therein and (ii) agrees that any action or proceeding in respect of any claim arising out of or related in any way to this Agreement or the Account shall be brought exclusively in a court of competent jurisdiction located therein.
11. Entire Agreement; Invalidity; Waiver; Benefit. If any part of this Agreement is held to be illegal or invalid, the remaining parts shall not be Neither the Account Owner’s nor the Custodian’s failure to enforce at any time or for any period any of the provisions of this Agreement shall be construed as a waiver of such provisions. The Account shall be maintained for the exclusive benefit of the Account Owner or his or her Beneficiaries and may not be attached or alienated, unless permitted by law.
12. Legal Process.
a. If Custodian is served with a subpoena, warrant, request, levy, order, or garnishment request from a governmental authority, court or tribunal for information or records concerning the Account or you, Custodian will follow the advice of its legal counsel as to the appropriate response to such subpoena, warrant, request, levy, order or garnishment, and shall have no liability or responsibility whatsoever to you for doing so even if such advice shall turn out to have been mistaken. You acknowledge and agree that Custodian’s current policy (which is subject to change based on advice of legal counsel) is to comply with any such subpoena, warrant, request, levy, order or garnishment, as concerns information, records or funds.
b. If you are served with a subpoena, warrant, order, or other request from a governmental authority, court or tribunal for information or records concerning the Account or Custodian, you will provide Custodian with prompt written notice so that Custodian may seek a protective order or other appropriate remedy. If, in the absence of a protective order or other remedy or Custodian’s waiver, you are nonetheless legally compelled to disclose such requested information, you may, without liability hereunder, disclose only that portion of such information that your counsel advises you are legally required to disclose, provided that you shall use your best efforts to preserve the confidentiality of any information, including, without limitation, by cooperating with Custodian to obtain an appropriate protective order or other reliable assurance of confidential treatment by the governmental authority, court, or tribunal.
13. Assignment. Custodian reserves the right to assign this Agreement without your prior consent, provided that any assignee must be qualified under the Code to be an HSA custodian or Upon assignment of this Agreement, the assignee shall automatically become custodian of the Account. Custodian shall not be liable for any actions or failures to act neither on the part of any successor custodian or trustee, nor for any tax consequences that result from the transfer or distribution of the Accounts’ assets.
14. Amendment. Custodian shall have the right to amend or modify this Agreement at any time, including retroactively, to comply with the requirements of the Code and applicable law. Any material amendments, with materiality to be determined in the sole discretion of Custodian, shall require the Account Owner’s consent, by action or no action, and will be preceded by at least 30 days’ advanced written notice to the Account Owner, specifying the amendment and the proposed effective date. Unless otherwise required by law, the Account Owner is deemed to automatically consent to an amendment by continuing to maintain the Account after Custodian has sent notice of an amendment, which means that the Account Owner’s written approval is not required for the amendment to apply to the In the event that the Account Owner objects to the amendment by providing Custodian notice thereof in writing prior to the expiration of the 30-day period, Custodian will close the Account and the account balance, less any outstanding fees, will be transferred to a custodian or trustee qualified under the Code and application law or, at Account Owner’s election, distributed to the Account Owner.
15. Acknowledgement of the Agreement. The Account Owner acknowledges that he or she has received and read this As such, the Account Owner agrees to all terms of this Agreement, and further agrees that the information in the Account Owner’s Health Savings Account Application is true and accurate as of the date thereof.
ACKNOWLEDGMENT
You acknowledge that you have read and or printed a copy of this Health Savings Custodial Agreement and agree to abide by the terms of that Agreement.
The terms “you” and “your” refer to the Account Owner, the term “Depository” refers to the depository institution into which your HSA funds are deposited as set forth herein, and the terms “we”, “us” and “our” refer to Custodian. You understand that this Health Savings Account Deposit Agreement (“Deposit Agreement”) governs your deposit account (the “Account”) with a depository institution (“Depository”), along with any other documents applicable to your Deposit Account, including the attached Truth in Savings Account Disclosure (“Disclosures”), which are incorporated herein by reference. You understand that your Account is also governed by applicable law.
As Custodian for your HSA, we will place your funds into a deposit account at a Depository selected by us in our sole discretion. Depository may be any depository institution. The Account will be recorded on the records of Depository in our name as Custodian.
While we are acting as Custodian for your HSA, all contributions to your HSA (made by you, your employer, a family member or any other person) will be made to us, and we will deposit the funds into your Account. We will disburse funds from the Account pursuant to your Deposit Agreement with us.
You may not transfer the Account directly to another Depository. At your election, you may dismiss us as Custodian in accordance with the terms of the Custodial Agreement, and appoint a successor custodian authorized to act as such in relation to HSAs under the Code and applicable law. As soon as is practicable following written notice of the appointment of such a successor custodian, we will cause the funds in the Account to be transferred to the successor trustee or custodian as soon as is practicable. Upon transfer of the Account to a successor trustee or custodian, the successor trustee or custodian shall automatically become custodian of the Account and we shall have no liability from any actions or failures to act following the transfer, either on the part of any successor custodian or trustee for any tax consequences that result from the transfer of the account or the funds therein.
1.Deposit. Deposits may be made in person, electronically or by mail. Depository is not responsible for transactions mailed until Depository actually receives and records them. Depository may, in Depository’s sole discretion, refuse to accept particular instruments as deposits. Cash deposits are credited to your account according to this Deposit Other items you deposit are handled by Depository according to Depository’s usual collection practices. If an item you deposited is returned unpaid, Depository will debit your Deposit Account and adjust any interest earned. You are liable to us for the amount of any check or electronic transaction deposited into your Account that is returned, and all related costs and expenses related to the collection of some or the entire amount from you. Funds deposited to your Account are available in accordance with the Disclosures.
2. Compliance with Applicable Laws.
a. Your use of the Account is subject to your compliance with all applicable laws, which includes, but is not limited to: (i) all applicable rules, regulations, requirements, guidelines, and commentaries issued by any state or federal governmental authority with jurisdiction over the Account, Custodian, of Depository; (ii) the federal Bank Secrecy Act and related Anti-Money Laundering laws and regulations; (iii) applicable sections of the USA PATRIOT Act, implementing regulations related to Know-Your-Customer and Customer Identification Programs; and (iv) Article 4A of the Uniform Commercial Code as currently in effect.
b. Before you may use the Account, Custodian and/or Depository are required to obtain, verify, and record certain information provided by you for customer due diligence and identification purposes, including your name, address, taxpayer identification number, and date of birth. Until this information has been verified pursuant to applicable laws, the Account may not be used. During such time, Custodian may charge its customary fees for maintaining the Account; provided that upon request from the Account Owner, Custodian will close the Account and return funds to the original contributor.
3. Collection of Deposited Items. In receiving items for deposit or collection, Depository acts only as your agent and assumes no responsibility beyond the exercise of ordinary care. All items are credited subject to final settlement in cash or credits. Depository shall have the right to forward items to correspondents including all Federal Reserve Banks, and Depository shall not be liable for default or neglect of said correspondents for loss in transit, nor shall any correspondent be liable except for its own negligence. You specifically authorize Depository and Depository’s correspondents to utilize Federal Reserve Banks to handle such items in accordance with provisions of Regulation J (12 CFR Part 210), as revised or amended from time to time by the Board of Governors of the Federal Reserve System. In the event Depository is subject to local clearinghouse rules, you specifically authorize Depository to handle such items in accordance with the rules and regulations of the clearinghouse.
If Depository permits you to withdraw funds from your Deposit Account before final settlement has been made for any deposited item, and final settlement is not made, Depository has the right to charge your Deposit Account or obtain a refund from you.
In addition, Depository may charge back any deposited item at any time before final settlement for whatever reason. Depository shall not be liable for any damages resulting from the exercise of these rights. Except as may be attributable to Depository’s lack of good faith or failure to exercise ordinary care, Depository will not be liable for dishonor resulting from any reversal of credit, return of deposited items or for any damages resulting from any of those actions.
1. Deposits will be available for withdrawal consistent with the terms of the Withdrawals may be subject to a service charge. Depository has the right to require seven days prior written notice from you of your intent to withdraw any funds from your account. Withdrawals may be subject to a service charge.
2. Set-offs. Depository may set-off funds in your Deposit Account and any other accounts held by you, jointly or individually, to pay any debt you may owe Depository or If the Deposit Account(s) is/are held jointly, Depository may offset funds for the debt of any one of the joint owners.
3. Claims. In response to any garnishment, attachment, restraining order, injunction, levy, citation to discover assets, judgment, reclamation, other order of court or other legal process (“Claim(s)”), Depository has the right to place a hold on, remove from your Deposit Account(s) and/or remit to the designated third-party(ies) any amount on deposit in your Deposit Account as set forth in and required by such Claim(s). If the Deposit Account(s) is/are held jointly, Depository may place the hold, remove from the Deposit Account(s) and/or remit the amounts from the Deposit Account(s) arising from any Claim(s) relating to any one or more of the account holders. In addition, Depository may charge against your Deposit Account(s) any fee authorized by law in connection with the Claim(s) or as otherwise set forth in the Disclosures.
4. You agree to be liable to Depository or Custodian for any loss, cost or expense that Depositor or Custodian incurs as a result of any dispute involving your Deposit Account, including reasonable attorneys’ fees to the extent permitted by law, and you authorize Depository to deduct such loss, cost or expense from your Deposit Account without prior notice to you.
5. Dormant You understand that if your Deposit Account is dormant, you may be charged the fee specified in the Disclosures and Depository may stop paying interest to the extent permitted by law. You understand that your Deposit Account balance may be escheated (that is, turned over to the state) in accordance with state law. Custodian’s general policy is that dormant Deposit Accounts are designated to Depository for escheatment after a dormancy period of three years. However, please be aware that each state has its own dormancy period and shorter or longer dormancy periods may apply depending on your state of residence. If your account does become dormant, Custodian will provide 90 days written notice prior to designating the deposit account for escheatment. The notice to you will provide you with a cure period and may explain what actions you may take to keep your Deposit Account open. When a Deposit Account is escheated, Depository will close the Deposit Account and the funds will subsequently be escheated to the state of residence on file for you. Once the funds in your Deposit Account are escheated, you may be able to recover the funds from the state. You understand and agree that neither Depository nor Custodian are responsible to you for any funds that are escheated to a state.
6. Joint Accounts, Trust Accounts and Custodial You acknowledge, it is your sole responsibility to determine the legal effects of opening and maintaining a Deposit Account designated as a Joint Account, a Trust Account, or a Custodial Account.
a. In Trust For If the Deposit Account is designated as an In Trust For account, you may change the named beneficiary at any time by written direction to Custodian. Upon your death, or if there are two or more trustees, upon the death of the last trustee, the amount then on deposit together with the interest may be paid to the beneficiary or to the beneficiary’s legal representative. Depository will not release any funds, however, until all legal documents have been delivered to Depository. Depository will not be liable for any payments or withdrawals made in accordance with state law.
b. Custodial A custodial account is subject to applicable law as adopted by the state in which the account is opened. The documents that authorize the custodianship may be required for the account.
c. Beneficiary Where a specific beneficiary designation for the Deposit Account is made to a person other than your current spouse, a written and executed spousal waiver or consent will be needed for Custodian to effect the designation.
7. Power of Attorney. If you wish to name another person to act as your attorney in fact or agent in connection with your Deposit Account, you must obtain the prior written approval of Depository and Custodian for the form of appointment. Neither Depository nor Custodian has any duty to determine the validity of such appointments or any instrument appointing your attorneys-in-fact or agents. Neither Depository nor Custodian shall be responsible for losses of any kind that may result from directions, actions, omissions or failures to act by your attorney-in-fact or agent, and you agree to reimburse Depository and/or Custodian for any losses they may respectively incur as a result of such directions, actions, omissions or failures to act by your attorney in fact or agent.
8. Fees, Service Charges and Balance Requirements. You agree you are responsible for any fees, charges, balance, or deposit requirements as stated in the Disclosures. Depository also reserves the right to impose a service charge for cashing checks drawn on your Deposit Account if the person cashing the check is not a customer of Depository. If your Deposit Account balance is $0 for 12 consecutive months, Custodian may, at its discretion, direct Depository to close the Deposit Account upon 60 days prior written notice to you. Custodian will provide 30 days written notice prior to closing the account. If your account has a negative balance for any period of time, Custodian will provide 10 days written notice prior to closing the account.
9. Amendments and You agree that the terms and conditions governing your Deposit Account may be amended by Depository or Custodian from time to time. Depository or Custodian will notify you of amendments as required by applicable law. Your continued use of the Deposit Account evidences your agreement to any amendments. Notices will be sent to the most recent address shown on the Account records. Only one notice will be given in the case of joint account holders.
10. Notices. You are responsible for notifying Custodian of any address or name changes, the death of an account holder or other information affecting your Deposit Notices must be in a form and manner acceptable to Custodian with enough information to allow Custodian to identify the Account. Notice sent by you to us is not effective until Depository has received it and has a reasonable opportunity to act on it. Written notice sent by Depository or Custodian to you is effective when mailed to the last address supplied to Custodian.
11. Closing Depository may close your Deposit Account at any time, with or without cause, by sending you notice and a check for the balance in Depository’s possession to which you may be entitled. At Depository’s discretion, Depository has the authority to pay an otherwise properly payable check, which is presented after the closing of your Deposit Account.
12. Transfers and You cannot assign or transfer any interest in your Deposit Account unless Custodian and Depository both agree in writing.
13. Applicable Laws and Regulations. This Deposit Agreement shall be governed by federal law and regulations and to the extent applicable, the laws of the State of Arizona, provided, however, your rights to the Deposit Account may be governed by the laws of the state in which the Deposit Account is opened, unless federal law Changes in these laws may change the terms and conditions of your Deposit Account. Custodian will notify you of any changes as required by law.
14. ACH and Wire Transfers. Fund transfers from the Deposit Account shall bes subject to Article 4A of the Uniform Commercial Code as adopted by the state in which the Deposit Account is If you send or receive a wire transfer, you agree that Fedwire ® Funds Service may be used. Regulation J of the Board of Governors of the Federal Reserve System is the law that covers transactions made over Fedwire ® Funds Service. When you originate a funds transfer for which Fedwire ® Funds Service is used, and you identify by name and number a beneficiary financial institution, an intermediary financial institution or a beneficiary, Custodian, Depository and every receiving or beneficiary institution may rely on the identifying number to make payment. Custodian and Depository may rely on the number even if it identifies a financial institution, person or account other than the one named. If you are a party to an Automated Clearing House (“ACH”) entry, you agree to be bound by the Operating Rules and Guidelines of the National Automated Clearing House Association (“NACHA”), the rules of any local ACH operator, and the rules of any other system through which the entry is made.
15. Provisional Payment. Any credit Depository gives you with respect to an ACH credit entry is provisional until Depository receives final settlement for that entry through a Federal Reserve Bank. If Depository does not receive final settlement with respect to such credit, you agree that Depository is entitled to a refund of the amount credited to you in connection with the entry, and the party making the payment to you via such entry (i.e., the originator of the entry) shall not be deemed to have paid you in the amount of such entry.
16. International ACH If any transactions related to your Deposit Account originates from a financial institution that is outside of the territorial jurisdiction of the United States, it may be subject to additional review for compliance with the rules of the Office of Foreign Assets Control (OFAC). If additional review is required, the international ACH transaction will not be available to you until it passes final verification.
17. Notice of Receipt. Under the Operating Rules and Guidelines of NACHA, which are applicable to ACH transactions involving your Deposit Account, Depository and Custodian are not required to give next day notice to you of receipt of an ACH entry and Depository and Custodian will not do so. However, Depository and Custodian will continue to notify you of the receipt of payments in the periodic statements Custodian provides to you.
18. NACHA Depository may accept on your behalf payments to your Deposit Account which have been transmitted through one or more ACH operators and which are not subject to the Electronic Fund Transfer Act, and your rights and obligations with respect to such payments shall be construed in accordance with and governed by the Operating Rules and Guidelines of NACHA.
19. Payment of Interest. If this is an interest-bearing account, the interest is calculated and paid in accordance with the Disclosures.
20. Checks. All negotiable paper (“checks”) presented for deposit must be in a format that can be processed and Depository may refuse to accept any check that does not meet this requirement. All endorsements on the reverse side of any check deposited into your Deposit Account or on any check issued by you must be placed on the left side of the check when looking at it from the front, and must be placed so as to not go beyond an area located 1.5 inches from the left edge of the check when looking at it from the front. It is your responsibility to ensure that this requirement is met and you are responsible for any loss incurred by Depository for failure of an endorsement to meet this requirement.
21. Substitute Checks. To make check processing faster, federal law permits financial institutions to replace original checks with “substitute ” These checks are similar in size to original checks with a slightly reduced image of the front and back of the original check. The front of a substitute check states: “This is a legal copy of your check. You can use it the same way you would use the original check.” You may use a substitute check as proof of payment just like the original check. Some or all of the checks that you receive back from Depository may be substitute check(s).
22. Non-Sufficient Funds. If your Deposit Account lacks sufficient available funds to pay a check, preauthorized transfer, or other debit activity presented for payment, Depository may return such item for non-sufficient funds and will charge you a fee as provided in the Depository’s processing order is: All credit transactions are processed first. Debits, or withdrawals, from your Deposit Account will be processed as follows: electronic items such as ATM and Pre-Authorized transactions then checks. The items are processed in the order received within each category.
23. Stop Payments. If you request Depository to stop payment on a check you have written, or on a preauthorized transfer, you will give written or other confirmation as allowed by Depository within 14 days of making the request. If you fail to confirm an oral stop payment request within the 14 days, Depository reserves the right to cancel the request. Requests to stop all future payments on a preauthorized transfer may require additional documentation to be supplied to Depository. Your stop payment request must describe the item or account with reasonable certainty, and Depository must receive the request in a time and way that gives Depository a reasonable opportunity to act on it. A stop payment on a check you have written will remain in effect for 6 months or until Depository receives written revocation of the stop payment, whichever occurs A stop payment on a preauthorized transfer will remain in effect until Depository receives a withdrawal of the stop payment request or the return of the debit entry(ies), whichever occurs first. You understand that Depository may accept the stop payment request from any of the joint owners of the account, regardless of who signed the check or authorized the transfer. Depository’s acceptance of a stop payment request does not constitute a representation by Depository that the item has not already been paid or that Depository has had a reasonable opportunity to act on the request. Depository may accept a stop payment request on lost or stolen checks, whether a single check or a series, unless Depository’s policy requires that Depository open a new account for you to ensure your security.
24. Statements. Custodian will provide you with a periodic statement showing the Deposit Account activity, either by email, mail or posted to Custodian’s website. The Account Owner who receives this statement is the agent for his/her co- account holder(s) for purposes of receiving the statement and You must notify Custodian within 30 days after Custodian mails or otherwise make the statement available to you of any discrepancies. If you fail to notify Custodian, you will have no claim against Depository. However, if the discrepancy is the result of an electronic fund transfer, the provisions of the Disclosures will control its resolution. If you do not receive a statement from Custodian because you have failed to claim it or have supplied Custodian with an incorrect mail or email address, Custodian may stop sending your statements until you specifically make written request that Custodian resume sending your statements and you supply Custodian with a valid address.
25. Stale or Postdated Checks. Depository reserves the right to pay or dishonor a check more than 6 months old without prior notice to If you can write checks on your Deposit Account, you agree not to postdate any check drawn on the Deposit Account. If you do and the check is presented for payment before the date of the check, Depository may pay it or return it unpaid. Depository is not liable to you for paying any stale or postdated check, and you agree to reimburse Depository for any loss Depository might suffer, as long as Depository acted in good faith or exercised ordinary care. Any damages that you incur, and which Depository may be liable for, are limited to actual damages not to exceed the amount of the check.
26. Check Safekeeping: If you utilize a check safekeeping or any other system offered by Depository for the retention of your checks, you understand that the canceled checks will be retained by Depository and destroyed after a reasonable time period or as required by law. At your request, Depository will provide without charge up to 25 canceled instruments or legible copies of the fronts and backs thereof per calendar year. Additional copies may be subject to a fee, as indicated in the Schedule of Fees or Disclosures. If for any reason Depository cannot provide you with a copy of a check, Depository’s liability will be limited to the lesser of the face amount of the check or the actual damages sustained by you.
27. Facsimile Signatures. You authorize Depository, at any time, to charge you for all checks, drafts, or other orders for the payment of money, that are drawn on Depository regardless of by whom or by what means the facsimile signature(s) may have been affixed so long as they resemble the facsimile signature specimen in our files and contain the required number of signatures for this purpose.
28. Restrictive Legends. Depository is not required to honor any restrictive legend on checks you write unless Depository has agreed to the restriction in a writing signed by an officer of Depository.
29. No You understand and agree that no delay or failure on Depository’s part to exercise any right, remedy, power or privilege available to Depository under this Agreement shall affect or preclude Depository’s future exercise of that right, remedy, power or privilege.
30. Negative Balances. According to the Internal Revenue Code Section 4975, if an HSA transaction results in a negative balance, the HSA will cease to be an HSA on the first day of the year in which the prohibited transaction occurred. The account will be closed.
ACKNOWLEDGMENT
I acknowledge that:
I have provided my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
I am a U.S. citizen or legal resident of the U.S.; and
I have read and or printed a copy of this Deposit Agreement and agree to abide by the terms of this Deposit Agreement.
All signers authorize Custodian and Depository to make inquiries from any consumer reporting agency, including a check protection service, in connection with the Account and the Deposit Account.
HEALTH SAVINGS ACCOUNT FEE DISCLOSURE
Custodian reserves the right to charge the below fees:
FEES AND CHARGES
| Trustee to Trustee transfer or Rollover (outgoing) | $25.00 |
| Non-sufficient funds (NSF)(can be created by check or other electronic means) | $30.00 |
| Periodic paper statement | Up to a $1.95 |
| **Paper statement fee charged periodically – Please note you may opt in to receive free electronic statements online by choosing HSA statements and setting your preference. | |
TRANSACTION LIMITATIONS
Deposit Accounts cannot be transferred without consent from Custodian. We reserve the right to require at least seven days written notice before any withdrawal or transfer.
ACKNOWLEDGMENT
You acknowledge that you have read and or printed a copy of this Fee Disclosure and agree to abide by the terms of such.