With a Beneficiary

If an HSA accountholder dies with a named beneficiary, the following is required from EMPOWER to receive disbursement:

1. copy of the death certificate that lists all of the following of the deceased:
   1. Address
   2. Social Security Number
   3. Date of Death

Without a Beneficiary

If an HSA accountholder dies without a named beneficiary, the following is required from EMPOWER to receive disbursement:

1. A Letter of Administration that appoints a qualified administrator of the estate.
2. The following information regarding the qualified administrator:
   1. Address (to receive the disbursement)
   2. Full Name
   3. Birth Date
   4. Social Security Number
3. A copy of the death certificate that lists all of the following of the deceased:
   1. Address
   2. Social Security Number
   3. Date of Death