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Health Reimbursement Arrangement (HRA)

Most Frequently Used Forms
Reimbursement Request Form HRA, FSA, Transportation Download
Direct Deposit Form HSA, HRA, FSA, Transportation Download
Additional Card Request Form HRA, FSA, Transportation Download
Authorized Representative Request Form (HIPAA) HRA, FSA Download
Benefits Termination Form HSA, HRA, FSA, Transportation Download
Receipt and Substantiation Form HRA, FSA Download
Medical Necessity Form HRA, FSA Download
Reimbursement and Substantiation
Substantiation Requirements HRA, FSA Download
Medical Necessity Form HRA, FSA Download
Reimbursement Request Form HRA, FSA, Transportation Download
Automatic Ortho Request HRA, FSA Download
Receipt and Substantiation Form HRA, FSA Download
Qualifying Child and Relative Questionnaire General, HSA, HRA, FSA, Consultants Download
IIAS Merchant List General, HSA, HRA, FSA Download
Enrollment
HRA Participant Guide HRA, Consultants Download
Administrative
Benefits Termination Form HSA, HRA, FSA, Transportation Download
FSA, HRA Rollover Certification HSA, HRA, FSA Download
Additional Card Request Form HRA, FSA, Transportation Download
Flex, HRA, HSA Privacy Agreement HSA, HRA, FSA Download
Email Notification Form HRA, FSA, Transportation Download
Authorized Representative Request Form (HIPAA) HRA, FSA Download
Plan Implementation
HRA Enrollment Form HRA Download
Design Guide General, HSA, HRA, FSA, Transportation Download
Design Guide Workbook HSA, HRA, FSA, Transportation Download
HRA Employer Resource Guide HRA Download
Withdrawal and Direct Deposit
Direct Deposit Form HSA, HRA, FSA, Transportation Download
IRS Publications
IRS Publication 502 - Medical Expenses HSA, HRA, FSA Download
DBI Newsletters
New Debit Card Regulations Handout HRA, FSA Download