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Flexible Benefits (FSA)

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
Direct Deposit Form HSA, HRA, 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 FSA Download
Substantiation Requirements Refresher HRA, FSA 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
Deductible Verification Form Reimbursement Accounts HRA, FSA Download
IIAS Merchant List HSA, HRA, FSA Download
Medical Necessity Form HRA, FSA Download
Qualified Reservist Distribution (QRD) Request Form FSA Download
Qualifying Child and Relative Questionnaire General, HSA, HRA, FSA, Consultants Download
Receipt and Substantiation Form - Debit Card Transactions HRA, FSA Download
Reimbursement Request Form HRA, FSA Download
Substantiation Requirements Refresher HRA, FSA Download
Enrollment
Employee Guide FSA FSA Download
Employee Guide FSA Spanish Version FSA Download
Enrollment Form FSA FSA Download
Flexible Spending Accounts - One Page Employee Handout FSA Download
Premium Conversion Waiver Form FSA Download
Administrative
Additional 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
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
Rollover Certification FSA HRA HSA, HRA, FSA Download
Status Change Form FSA FSA Download
Plan Implementation
Employer Resource Guide Flex FSA, Consultants Download
Non-Discrimination Testing File Template FSA Download
Non-Discrimination Testing Workbook FSA, Consultants Download
Withdrawal and Direct Deposit
Direct Deposit Form HSA, HRA, FSA Download
IRS Publications
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