• Healthcare acknowledgment (whether you elect or decline)
  • Are you taking employee plus spouse or family coverage?
    • We will need the spousal authorization form if you are insuring your spouse
  • Are you new to HSA?
    • We will need the First Financial application form, a copy of your driver’s license, and the HSA deduction authorization.
  • Not new to HSA?
    • We need the HSA deduction authorization
  • Taking any of the FSA accounts?
    • We need the signed authorization for each one
  • Not taking the FSA?
    • Nothing! No forms required
  • Taking dental and/or vision?
    • We need the dental and/or vision authorization form
  • Not taking dental OR vision?
    • Nothing! No forms required
  • Beneficiary form
    • For the City provided coverage even if you do not elect supplemental

City Hall

Location

123 Washington Street
Columbus, Indiana 47201
(812) 376-2500
TDD: Call 711
Fax: (812) 376-2564
Contact Us

Hours
Monday – Friday
8:00 a.m. – 5:00 p.m.