Employees/Members
Employees/Members Online Access Login Page
Online Access Registration Instructions
General Forms
FLEX Forms
These forms should be printed, filled out & signed.
Then fax or mail as per instructions on the individual forms.
- 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 Worksheet
* to assist you with computing your annual enrollment - FLEX Additional Debit Card Request Form
* Complete if you want a debit card for a spouse or dependent child - FLEX Letter of Medical Necessity
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
Helpful Hints
Provider Networks
- Provider Networks Page
* Use this to check to see if a provider is in your network
Other Links:
- WebMD
- Link to Wellmark Forms
* access Wellmark's forms via this link to their website - Request Additional Wellmark Card
