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Flexible Benefits (FSA)

Most Frequently Used Forms
Additional Debit 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 Enrollment/Change Form HSA, HRA, FSA Download
Medical FSA and HSA Eligibility List HSA, FSA Download
Medical Necessity Form HRA, FSA Download
Receipt and Substantiation Form HRA, FSA Download
Reimbursement Request Form HRA, FSA Download
Status Change Form FSA Download
Substantiation Requirements Refresher HRA, FSA Download
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 HSA, HRA, FSA Download
Receipt and Substantiation Form HRA, FSA Download
Reimbursement Request Form HRA, FSA Download
Substantiation Requirements Refresher HRA, FSA Download
Employee Guide: Flexible Spending Accounts (FSA) - Spanish Version FSA Download
Employee Guide: Flexible Spending Accounts (FSA) FSA Download
Flexible Spending Account Enrollment Form FSA Download
Flexible Spending Accounts - One Page Employee Handout FSA Download
Premium Conversion Waiver Form FSA Download
Additional Debit Card Request Form HRA, FSA Download
Adoption FSA Plan Summary FSA Download
Authorized Representative Request Form (HIPAA) HRA, FSA Download
Benefits Termination Form - Reimbursement Accounts HSA, HRA, FSA Download
Consumer Portal: User's Guide General, FSA Download
HSA Rollover Certification Form HSA, HRA, FSA Download
Leave of Absence (LOA) Form FSA Download
Privacy Agreement Reimbursement Accounts HSA, HRA, FSA Download
Qualified Reservist Distribution (QRD) Employer Plan Amendment Request Form FSA Download
Status Change Form FSA Download
Employer Resource Guide Flex FSA, Consultants Download
Non-Discrimination Testing File Template FSA Download
Non-Discrimination Testing Workbook FSA, Consultants Download
Direct Deposit Enrollment/Change Form HSA, HRA, FSA 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 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