Employee/Member Forms
These forms should be printed, filled out & signed.
Then fax or mail as per instructions on the individual forms.
Flex Forms
- 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 Request
* use when filing a manual claim - Flex Eligible Reimbursable Expenses
- 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
HRA Forms
- HRA Eligible Reimbursable Expenses
- 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
Insurance Carrier Forms
- Link to Wellmark Forms
* access Wellmark's forms via this link to their website - Request Additional Wellmark Card
