FLEXsmart Forms
These forms should be printed, filled out & signed.
Then fax or mail per instructions on the individual forms.
FLEXsmart Worksheet
* to assist you with computing your annual enrollment
FLEXsmart Enrollment Form
* for enrollments and re-enrollments
FLEXsmart Enrollment Change Form
* new baby or other life changing events? - Please let us know.
FLEXsmart Reimbursement Form
* use when filing a manual claim
FLEXsmart Eligible Reimbursable Expenses
* Listing of eligible reimbursable expenses for Medical Spending
Account, HRA's, and Dependent Care Accounts
Direct Deposit Form
* have your reimbursements faster and easier direct to your
checking or savings!
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How to Forms
How to Read Your EOB
Mediweb User Guide
Release Forms
RQST to RLS EOB
Wellmark EOB Release Form
Informative Videos
Learn how to keep your Rx costs down, watch our
Drug Smart Video.
EBS Contacts
Manager Contact list
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