Employers

Employers Online Access Login Page

     Online Access Registration Instructions

FLEX Forms

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

• FLEX Funding and Processing


• FLEX Enrollment Form


• FLEX Worksheet
      * to assist you with computing your annual enrollment
  
  
• FLEX Enrollment Change Form
      * new baby or other life changing events? - Please let us know.
  
  
• FLEX Reimbursement Form (with debit card)
• FLEX Reimbursement Form (without debit card)
      * use when filing a manual claim
  
  
• FLEX Eligible Reimbursable Expenses
      * Listing of eligible reimbursable expenses for Flex accounts


• FLEX Direct Deposit Form
      * have your reimbursements faster and easier, direct to your
        checking or savings!
  
  
• FLEX Additional Debit Card Request Form
      * Complete if you want a debit card for a spouse or dependent child

HRA Forms

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

• HRA Enrollment Change Form
  
  
• HRA Eligible Reimbursable Expenses
      * Listing of eligible reimbursable expenses for HRA accounts
  
  
• HRA Reimbursement Request
      * use when filing a manual claim
  
  
• Direct Deposit Request
      * get your reimbursements faster and easier, direct to your
        checking or savings!
  
  
• Additional Debit Card Request
      * Complete if you want a debit card for a spouse or dependent child

COBRA Forms

• COBRA Plan Information Sheet


• COBRA Eligibility Form
      * Notification for employee & dependent adds, terminations, and changes


• COBRA Participant Information Form
      * Listing of current COBRA participants