- 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.