FLEX Forms

FLEX Forms

These forms should be printed, filled out & signed.
Then fax or mail as per instructions on the individual forms.

• FLEX Enrollment
      * For enrollments and re-enrollments


• FLEX Enrollment Change
      * New baby or other life changing events? Please let us know!


• FLEX Request for Reimbursement
      * use when filing a manual claim
  
  
• FLEX Worksheet
      * To assist you with computing your annual enrollment


• FLEX Direct Deposit Request
      * Get your reimbursements faster and easier--direct to your checking or savings!


• FLEX Additional Debit Card Request
      * Complete if member wants a debit card for a spouse or dependent child