|90% Rule Merchant List||This is a list of merchants that have registered with SIGIS as meeting the IRS 90% Rule which requires that at least 90% of gross sales are from prescriptions/Rx or qualified over-the-counter health care products. Meeting this rule means that the debit card may be used at this location. You will still be required to submit substantiation for purchases made at merchants meeting the 90% rule and who do not have IIAS. ||FSA, General, HRA, HSA||Resources|
|Authorized Representative Form - HIPAA (Flex and COBRA)||Complete this form to communicate authorization to DBI to release information on your FSA,HSA,HRA,or COBRA to another individual.||COBRA, FSA, HRA, HSA||Forms|
|Benefits Debit Card PIN Option FAQs||---||FSA, HRA, Transportation||Forms|
|Benefits Termination Form||This form is to terminate one or more benefit(s) continued through COBRA.
If participating in ACH, please note we need to receive notification at least 15 days prior to the 1st of the month of your requested termination. If this form is received after that timeframe, we cannot guarantee that the ACH payment for that month will be canceled. However, if a payment is withdrawn, you will be refunded via check.
|COBRA - Addition of Dependent ||This is for adding any dependents to your coverage.
If the additional dependent is due to a marriage, birth or adoption, notification of the additional dependent must be made within 30 days of the qualifying event, or the request may be denied by the insurance carrier.
|COBRA - Contact Information Change||This form is to update contact information such as mailing address, telephone number, and email address. ||COBRA||Forms|
|Dependent Care Documentation||---||FSA||Forms|
|Discovery Benefits Privacy Notice||---||General||Guides|
|Discovery Benefits Terms of Service||---||General||Resources|
|Employee Guide: Flexible Spending Account (FSA)||Use this guide as your flexible benefits handbook. ||FSA||Guides|