Employer Information
Plan Renewal Materials
2021
Calendar
Calendar
2021 Calendar
Basic FSA and HSA
Census
Census
Basic FSA HSA Census
2024
Calendar
Calendar
2024 Calendar
FSA/DCA Forms
Enrollment
Form
Form
Enrollment Form
FSA
Brochure
Brochure
FSA Brochure
Eligible
Expenses List
Expenses List
Eligible Expenses List
Worksheet to Estimate Expenses
Worksheet/Estimate Expenses
Benefit Card
Request
Request
Benefit Card Request
Benefit Card
Substantiation Guide
Substantiation Guide
Benefit Card Substantiation Guide
Benefit Card Employee
Welcome Letter
Welcome Letter
Benefit Card Welcome Letter
Pay to Provider
Claim Form
Claim Form
Pay to Provider Claim Form
General
Claim Form
Claim Form
General Claim Form
General Claim
Form – Spanish
Form – Spanish
General Claim Form - Spanish
Direct Deposit
Agreement
Agreement
Direct Deposit Agreement
Direct Deposit
Agreement – Spanish
Agreement – Spanish
Direct Deposit Agreement-Spanish
Direct Deposit
Info Sheet
Info Sheet
Direct Deposit Info Sheet
Direct Deposit Info
Sheet – Spanish
Sheet – Spanish
Direct Deposit Info Sheet - Spanish
Eligible Expense
Scanner
Scanner
Eligible Expense Scanner
Employee Portal
Login Instructions
Login Instructions
Employee Portal Login Inst.
Employee Portal
Access w/Mobile
Access w/Mobile
Employee Portal Access w/Mobile
Employee Portal Access
w/Mobile -Spanish
w/Mobile -Spanish
Employee Portal Mob. Acc. Spanish
Mobile App
Fact Sheet
Fact Sheet
Mobile App Fact Sheet
Mobile App Fact
Sheet – Spanish
Sheet – Spanish
Mobile App Fact Sheet - Spanish
FAQ – FSA
With Grace Period
With Grace Period
FAQ -FSA With Grace Period
FAQ – FSA
With Rollover
With Rollover
FAQ - FSA With Rollover
FAQ –
LP FSA
LP FSA
FAQ - LP FSA
Overview
DCA
DCA
Overview DCA
Overview – FSA
with Grace Period
with Grace Period
Overview - FSA w/Grace Period
Plan Sponsor
Portal User Guide
Portal User Guide
Plan Sponsor Portal User Guide
HIPAA
Authorization Form
Authorization Form
HIPAA Authorization Form
Parking/Transit Forms
Enrollment Form
Parking & Transit
Parking & Transit
Enrollment Form Parking & Transit
Parking & Transit
Brochure
Brochure
Parking & Transit Brochure
Parking & Transit
Claim Form
Claim Form
Parking Transit Claim Form
Demographic
Update Request
Update Request
Demographic Update Request
HSA Forms
HSA Enrollment
Form
Form
HSA Enrollment
Benefit Card
Request
Request
Benefit Card Request
Direct Deposit
Form
Form
Direct Deposit Form
Eligible Expenses
List
List
Eligible Expenses List
FAQ
HSA
HSA
FAQ HSA
HIPAA
Authorization Form
Authorization Form
HIPAA Authorization Form
Overview – HSA
for Employers
for Employers
Overview HSA for Employers
Overview-
HSA
HSA
Overview - HSA
Overview-
HSA & LP FSA
HSA & LP FSA
Overview HSA & LP FSA
Demographic
Update Request
Update Request
Demographic Update Request
Benefit Card Employee
Welcome Letter
Welcome Letter
Benefit Card Empl. Welcome Letter
HSA Beneficiary
Change
Change
HSA Beneficiary Change
HSA Contribution
Request
Request
HSA Contribution Request
HSA Distribution
Request
Request
HSA Distribution Request
HSA Distribution
Death
Death
HSA Distribution -Death
HSA Interest Rate
Disclosure
Disclosure
HSA Interest Rate Disclosure
HSA PoA
Disability
Disability
HSA PoA Disability
HSA Power of
Attorney
Attorney
HSA Power of Attorney
HSA Transfer
Form
Form
HSA Transfer Form
Information Update-
Name Change
Name Change
Information Update Name Change
HSA Custodial
Agreement 2021
Agreement 2021
Custodial Agreement 2021
FAQ – HSA Form
5498-SA 2023
5498-SA 2023
FAQ HSA 5498
HRA Forms
HRA
Enrollment Form
Enrollment Form
Enrollment Form HRA
Benefit Card
Request Form
Request Form
Benefit Card Request Form
Benefit Card
Substantiation Guide
Substantiation Guide
Benefit Card Substantiation Guide
HRA
Brochure
Brochure
HRA Brochure
Benefit Card Employee
Welcome Letter
Welcome Letter
Ben. Card Employee Welcome Ltr
Pay to Provider
Claim Form
Claim Form
Pay to Provider Claim Form
General
Claim Form
Claim Form
General Claim Form
General Claim
Form – Spanish
Form – Spanish
General Claim Form - Spanish
Direct Deposit
Info Sheet
Info Sheet
Direct Deposit Info Sheet
Direct Deposit
Info Sheet – Spanish
Info Sheet – Spanish
Pay to Provider Claim Form
Direct Deposit
Agreement
Agreement
Direct Deposit Agreement
Direct Deposit
Agreement – Spanish
Agreement – Spanish
Direct Deposit Agreement Spanish
Employee Portal
Login Instructions
Login Instructions
Employee Portal Login Instr.
Employee Portal
Information
Information
Employee Portal Information
Employee Portal
Information – Spanish
Information – Spanish
Employee Portal Information - Spanish
HRA Activation
Form
Form
HRA Activation Form
Plan Sponsor Portal
User Guide
User Guide
Plan Sponsor Portal User Guide
Demographic
Update Request
Update Request
Demographic Update Request
HIPAA
Authorization Form
Authorization Form
HIPAA Authorization Form
Eligible Expenses
HRA Unrestricted
HRA Unrestricted
Eligible Expenses HRA Unrestricted
COBRA Forms
Qualifying Event
Notification Form
Notification Form
Qualifying Event Notification Form
COBRA Legacy
Notification Form
Notification Form
COBRA Legacy Notification Form
Premium Collection
Notification Form
Notification Form
Premium Collection Notification Form
COBRA- Employee
Portal User Guide
Portal User Guide
COBRA- Employee Portal User Guide
Implementation Kits
FSA
Implementation Kit
Implementation Kit
FSA Kit
HRA
Implementation Kit
Implementation Kit
HRA Kit
HSA
Implementation Kit
Implementation Kit
HSA Kit
Parking & Transit
Implementation Kit
Implementation Kit
Parking & Transit Kit
COBRA
Implementation Kit
Implementation Kit
Premium Kit
Premium Collection
Implementation Kit
Implementation Kit
Premium Collection
Premium Only (POP) Plan
Implementation Kit
Implementation Kit