Employee/Member
Flex Services

Flex Forms

These forms should be printed, filled out & signed.
Then fax or mail as per instructions on the individual 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 Form
      * use when filing a manual claim
  
  
• Flex Eligible Reimbursable Expenses
      * Listing of eligible reimbursable expenses for Flex accounts


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