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All Forms

Most Frequently Used Forms
Additional Card Request Form HRA, FSA Download
Authorized Representative Request Form (HIPAA) HRA, FSA Download
Automatic Dependent Care Request Form FSA Download
Automatic Orthodontia Request Form HRA, FSA Download
Benefits Termination Form Reimbursement Accounts HSA, HRA, FSA Download
Consumer Portal: User's Guide General, FSA Download
DCA Eligibility List FSA Download
Direct Deposit Form HSA, HRA, FSA Download
Employee Guide: WiredCommute Transportation Download
Medical FSA and HSA Eligibility List HSA, FSA Download
Medical Necessity Form HRA, FSA Download
Receipt and Substantiation Form - Debit Card Transactions HRA, FSA Download
Reimbursement Request Form HRA, FSA Download
Status Change Form FSA Download
Substantiation Requirements Refresher HRA, FSA Download
Withdrawal Form HSA HSA Download
Reimbursement and Substantiation
90% Rule Merchant List General, HSA, HRA, FSA Download
Automatic Dependent Care Request Form FSA Download
Automatic Orthodontia Request Form HRA, FSA Download
DCA Eligibility List FSA Download
Deductible Verification Form HRA, FSA Download
IIAS Merchant List HSA, HRA, FSA Download
Medical FSA and HSA Eligibility List HSA, FSA Download
Medical Necessity Form HRA, FSA Download
Qualified Reservist Distribution (QRD) Request Form FSA Download
Receipt and Substantiation Form - Debit Card Transactions HRA, FSA Download
Reimbursement Request Form HRA, FSA Download
Substantiation Requirements Refresher HRA, FSA Download
WiredCommute - Lost Pass Form Transportation Download
Withdrawal Form HSA HSA Download
Enrollment
CMS (Centers for Medicare & Medicaid Services) - COBRA Subsidy Denial Appeal Application Form COBRA Download
DOL (US Department of Labor) Appeal Application - COBRA Subsidy Denials COBRA Download
Employee Guide: Flexible Spending Accounts (FSA) - Spanish Version FSA Download
Employee Guide: Flexible Spending Accounts (FSA) FSA Download
Employee Guide: Health Reimbursement Arrangements (HRA) HRA, Consultants Download
Employee Guide: WiredCommute Transportation Download
Enrollment Application HSA HSA Download
Enrollment Form FSA FSA Download
Flexible Spending Accounts - One Page Employee Handout FSA Download
Premium Conversion Waiver Form FSA Download
Administrative
Addition of a Dependent Form COBRA Download
Additional Card Request Form HRA, FSA Download
Adoption FSA Plan Summary FSA Download
Authorized Representative Request Form (HIPAA) HRA, FSA Download
Authorized Representative/HIPAA Form COBRA Download
Benefit(s) Termination Form COBRA Download
Benefits Termination Form Reimbursement Accounts HSA, HRA, FSA Download
Consumer Portal: User's Guide General, FSA Download
Contact Information Change Form COBRA Download
Contribution Form HSA HSA Download
Death Beneficiary Change Form HSA HSA Download
DOL Sample Template - Initial Notice COBRA Download
Employee/Spouse/Dependent Notice of a Qualifying Event COBRA Download
FAQs for Employers - COBRA Subsidy American Recovery and Reinvestment Act of 2009 COBRA Download
Leave of Absence (LOA) Form FSA Download
MSP Reporting Requirements for HRAs HRA Download
Mutual Fund Expense Disclosure HSA HSA Download
Mutual Fund Investments HSA HSA Download
Privacy Agreement Reimbursement Accounts HSA, HRA, FSA Download
QE Sample Template - COBRA Eligible COBRA Download
Qualified Reservist Distribution (QRD) Employer Plan Amendment Request Form FSA Download
Rollover Certification FSA HRA HSA, HRA, FSA Download
Social Security Disability Extension (SSDE) Form COBRA Download
Status Change Form FSA Download
Plan Implementation
Custodial Account and Disclosure Statement HSA HSA Download
DOL Layout - Initial Notice COBRA Download
Employer Resource Guide Flex FSA, Consultants Download
Employer Resource Guide HRA HRA Download
HSA Resource Guide HSA Download
Non-Discrimination Testing File Template FSA Download
Non-Discrimination Testing Workbook FSA, Consultants Download
Resource Guide - COBRA COBRA Download
Withdrawal and Direct Deposit
Direct Deposit Form HSA, HRA, FSA Download
IRS Publications
DOL Model Notice (ARRA): Alternative Notice (Insurers - State Law) COBRA Download
DOL Model Notice (ARRA): General Notice (Abbreviated Version) COBRA Download
DOL Model Notice (ARRA): General Notice (Full Version) COBRA Download
DOL Model Notice (ARRA): Notice in Connection with Extended Election Periods COBRA Download
IRS Form 2441 - Dependent Care FSA Download
IRS Form 2441 Instructions FSA Download
IRS Form 8839 Instructions - Qualified Adoption Expenses FSA Download
IRS Form 8839 Qualified Adoption Expenses FSA Download
IRS Form 8889 HSA HSA Download
IRS Form 8889 Instructions HSA HSA Download
IRS Notice 2008-59 - Health Savings Accounts (6/25/2008) HSA Download
IRS Publication 502 - Medical Expenses HSA, HRA, FSA Download
IRS Publication 503 - Dependent Care FSA Download
IRS Publication 969 - Reimbursement Accounts (FSA, HSA, HRA) HSA, HRA, FSA Download
IRS Revised 2009 941 Form - Includes COBRA Subsidy COBRA Download
IRS Revised 2009 941 Form Instructions - Includes COBRA Subsidy COBRA Download
DBI Newsletters
Quarterly Communication Piece General Download