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Forms and documents
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forms & documents

Need a generic form or information document for your plan? Select your benefit below to see a listing of available forms and select the link to download a PDF of the form or document. Please make sure to download the latest version of Adobe Reader prior to opening the PDF documents.

Health Care FSA / Day Care FSA / Limited Health Care FSA / Wellness

claim form

day care service form

direct deposit form

letter of medical necessity

FSA plan overview

authorization form

Health Reimbursement Arrangement (HRA)

claim form

direct deposit forms

letter of medical necessity

authorization form

Health Savings Account

HSA welcome kit

HSA education guide

authorization form

HSA transfer form