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Employee Forms

• Interactive Claim Voucher (requires Adobe Acrobat/Acrobat Reader version 6.02 or later)

• Download Claim Voucher

• Direct Deposit Application

• Debit Card Enrollment Application

• Medical Expense Worksheet

• Download Enrollment Form

• HIPAA Privacy Statement and Authorization

HRA Employee Forms

• HRA Enrollment Form w/ Debit Card

• HRA Enrollment Form w/o Debit Card

• HRA Activation Form

• HRA Claim Form (How To)

Employer Forms

• Change of Status

• Claim Voucher

• Employee Survey

• Client Information Sheet - Full Flex Plan

• Client Information Sheet - POP

• Case Submission Sheet

• Tax Savings Worksheet

• Business Associate Agreement

• HSAToday™ Expense Detail and Request for Distribution

HRA Employer Forms

• Confidential Information for HRA Documents