Employer Forms

General Sales/Marketing Forms:

New Client Application

Broker Designation Form

Group Enrollment Upload Spreadsheet

Group Enrollment Upload Spreadsheet Instructions

Flex Forms:

FSA Enrollment Form

Limited Purpose FSA Enrollment Form

FSA Enrollment Kit

Letter of Medical Necessity

Member Messaging Options Form

HSA Enrollment Form

All Other HSA Forms (Directs to Website of our HSA banking partner, The Bancorp Bank)

Substantiation Request Form

Direct Deposit Form

HRA Enrollment Form

HRA Activation Form

CRA Change of Election Form

Plan Administrator Override Form

Employer Request for Service Form

Employee Request for Service Form

Electronic Upload Spreadsheet

POP Enrollment Form

Banking Change Form

COBRA Forms:

COBRA Request for Service Form

COBRA Open Enrollment Form

COBRA Rate Renewal Request Form

COBRA Participant Recurring ACH Form

Takeover/Legacy QB Form

Special Plan Member Form

New Plan Member Form

Qualifying Event Submission Form

Spanish Forms/Formas en Espanol:

Claim Form/Forma de Reclamo

Substantiation Request/Solicitud de Comprobacion

FSA Enrollment Form/FSA Formulario de Inscripcion

How to Use Your Card/Como Utilizar Su Tarjeta