This is the checklist of items we need to install any of the plans.
This form should be used for employees to make Elections and Election changes to their HRA and/or FSA plan.
This form will allow an employee to make a change to their election if they have a qualifying event.
This form is used to submit a Request for Reimbursement from your Dependent Care Account.
This form shows IRS Eligible Section 213(d) Expense descriptions and documentation required for Standard FSA Plans, Limited Purpose FSA Plans, and HRA Plans. NOTE: not all expenses may be eligible for your plan; please refer to your Employers Summary Plan Description for a list of eligible benefits your plan covers.
This form is used by the employees prior to the begining of each new plan year to elect the benefits the are participating in.
Use this form for Over-the-Counter purchases that require a Doctors Letter of Medical Determination Form. Have your provider complete and return with your claim submission.