Plan Participant Information
Healthcare and Dependent Care Accounts (FSA/DCA)
General Claim
Form
Form
General Claim Form
Benefit Card
Request
Request
Benefit Card Request
Employee Portal
Login Information
Login Information
Employee Portal Login Info
FAQ – FSA
With Rollover
With Rollover
FAQ - FSA With Rollover
Limited Purpose
FSA
FSA
Limited Purpose FSA
Pay To Provider
Claim Form
Claim Form
Pay to Provider Claim Form
Demographic Update
Request
Request
Demographic Update Request
Mobile App
Information
Information
Mobile App Information
Overview With
FSA Grace Period
FSA Grace Period
FSA Grace Period
Dependent Care
Information
Information
Dependent Care Information
Direct Deposit
Authorization
Authorization
Direct Deposit Auth.
HIPAA
Authorization
Authorization
HIPAA Authorization
Employee Portal
Guide
Guide
Employee Portal Guide
Eligible
Expense List
Expense List
Eligible Expense List
Open Enrollment
Brochure
Brochure
OE Brochure
Direct Deposit
Information
Information
Direct Deposit Information
Letter of Medical
Necessity
Necessity
Letter of Medical Necessity
Payment Card
Substantiation Information
Substantiation Information
Pymnt Card Substantiation Info.
Eligible Expense
Scanner
Scanner
Eligible Expense Scanner
Transaction Dispute
Form
Form
Transaction Dispute Form
Health Reimbursement Account (HRA)
General Claim
Form
Form
General Claim Form
Benefit Card
Request
Request
Benefit Card Request
Employee Portal
Login Information
Login Information
Employee Portal Login Info
HRA Activation
Form
Form
HRA Activation Form
Pay To Provider
Claim Form
Claim Form
Pay to Provider Claim Form
Demographic Update
Request
Request
Demographic Update Request
Mobile App
Information
Information
Mobile App Information
Transaction Dispute
Form
Form
Transaction Dispute Form
Direct Deposit
Authorization
Authorization
Direct Deposit Authorization
HIPAA
Authorization
Authorization
HIPAA Authorization
Employee
Portal Guide
Portal Guide
Employee Portal Guide
Eligible Expenses List
HRA Unrestricted
HRA Unrestricted
Eligible Expenses Unrestricted
Direct Deposit
Information
Information
Direct Deposit Information
Letter of Medical
Necessity
Necessity
Letter of Medical Necessity
Payment Card
Substantiation Information
Substantiation Information
Payment Card Substantiation Info.
Health Savings Account (HSA)
Distribution
Request
Request
Distribution Request
Letter of Medical
Necessity
Necessity
Letter of Medical Necessity
Eligible
Expense List
Expense List
HSA Eligible Expense List
HSA & Limited FSA
Fact Sheet
Fact Sheet
HSA & Limited FSA Fact Sheet
HSA Enrollment
Form
Form
HSA Enrollment Form
HSA Power of
Attorney
Attorney
HSA Power of Attorney
Contribution
Request
Request
Contribution Request
HSA Employee
Portal Guide
Portal Guide
HSA Employee Portal Guide
HSA
Overview
Overview
HSA Fact Sheet
Healthcare Bank
Custodial Agreement
Custodial Agreement
Heathcare Bank Cust. Agreement
HIPAA
AUTHORIZATION
AUTHORIZATION
HIPPA Authroization
Information Update
Name Change
Name Change
Info Update - Name Change
Transfer
Form
Form
Transfer Form
Employee Portal
Login Information
Login Information
Employee Portal Login
Health Savings
Account FAQ
Account FAQ
HSA FAQ
Healthcare Bank
HSA Disclosures
HSA Disclosures
HC Bank HSA Disclosures
HSA Beneficiary
Change
Change
HSA Beneficiary Change
Information
Update
Update
Information Update
Direct Deposit
Authorization
Authorization
Direct Deposit Auth.
Mobile App
Information
Information
Mobile App Info
Five Benefits of
Health Savings Accounts
Health Savings Accounts
5 Benets of an HSA
Benefit Card
Request
Request
Benefit Card Request
HSA PoA
Disability
Disability
PoA Disability
FAQ – HSA Form
5498- SA 2023
5498- SA 2023
FAQ HSA Form 5498- SA 2023
Parking/Transit
Parking/Transit
Claim Form
Claim Form
Parking/Transit Claim Form
Benefit Card
Request Form
Request Form
Benefit Card Request
Commuter Benefit
Brochure
Brochure
Commuter Benefit Brochure
Employee Portal
Guide
Guide
Employee Portal Guide
Demographic Update
Request
Request
Demographic Update Request
Employee Portal
Login Information
Login Information
Employee Portal Login
Direct Deposit
Authorization
Authorization
Direct Deposit Authorization
Mobile App
Information
Information
Mobile App Info
Direct Deposit
Information
Information
Direct Deposit Information
COBRA
ACH Authorization
Form
Form
ACH Authorization Form
COBRA Portal
Guide
Guide
