Important Information About Procedures for Opening a New Account:
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person that opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.
Acceptance of Terms:
By selecting "I Agree" underneath the "Disclosure Statement" on the online Medical Savings Account application I understand that annual fees are non-refundable and I apply to Idaho Independent Bank ("Bank" or "IIB") to establish a Medical Savings Account ("Account"). Upon the bank accepting my application and opening the Account, I authorize the bank to provide American Health Value all data requested by American Health Value regarding the account and any related information to the Account, including but not limited to contact information and transactions. American Health Value shall utilize such information to act as the benefit administrator of the account. I understand that I may terminate the sharing of my customer bank information at any time, but I must provide written instructions revoking this authorization to the Bank and provide the Bank a reasonable period of time to act upon my resignation. I understand that I have a separate contract with the Bank for banking services, of which American Health Value is not a party and I have a separate contract with American Health Value regarding benefit administration services, of which the bank is not a party.
I understand the American Health Value administrative fee will automatically be deducted from my Medical Savings Account on an annual basis.
The account holder is responsible for the establishment and maintenance of this account pursuant to state guidelines. American Health Value is here to assist the account holder in accomplishing this.
Medical Savings Account Trust Agreement:
The custodian and benefit administrator is authorized to act without further inquiry in accordance with writings bearing my signature. I understand that I may revoke the agreement by written notice to the custodian or administrator within seven (7) days after the date of the agreement as specified below.
This deposit account is subject to all rules and regulations applicable to Idaho Independent Bank, as well as all agreements entered into the Bank including but not limited to the account agreement. I understand the following: the Bank may order a consumer report from a credit reporting agency in order to evaluate my eligibility to open an account; I will be provided the account agreement, signature card and all applicable regulatory disclosures by the Bank upon its receipt and approval of my application to establish a Medical Savings Account; and, my account will not be opened until the signed signature card is returned to the Bank and IIB's account opening requirements have been met. IIB reserves the right to refuse to open and terminate an account for any reason.
I authorize my Benefit Administrator, American Health Value, and/or the Bank to make credit and debit entries to my Checking Account/MSA (Account), where the Bank is the custodian thereof, for the sole purpose of correcting any contributions that may be made in error to my Account. For purposes of this Authorization, Bank may also be referred to as the Depository.