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Employee Forms

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

• Direct Deposit Application

• Debit Card Application

• Medical Expense Worksheet

• Enrollment Form

• HIPAA Privacy Statement and Authorization

• OTC (Over-the-Counter) Prescription Form

• HSAToday™ Expense Detail and Request for Distribution

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

• Employee Survey

• Client Information Sheet - Full Flex Plan

• Client Information Sheet - POP

• Case Submission Sheet

• Tax Savings Worksheet

• Business Associate Agreement

• Model Amendment for adding Children to Age 26

HRA Employer Forms

• Confidential Information for HRA Documents