Forms

Forms & Educational Materials

HSA

HSA Check Order Form

HSA Account Maintenance Form

HSA Beneficiary Form

HSA Distribution Reversal Form

HSA Individual Contribution Correction Form

HSA Individual Contribution Form

HSA Transfer Form

HSA Welcome Guide

Benefits MasterCard Agreement

HSA Guided Portfolio FAQ

HSA Guided Portfolio Participant Overview

Health FSA

Benefits MasterCard Verification Form

Authorization Agreement for Direct Deposit

FSA & HSA Eligible Expenses

FSA & Dependent Care Reimbursement Claim Form

Letter of Medical Necessity Form

Benefits MasterCard Agreement

Dependent Care FSA

FSA & Dependent Care Reimbursement Claim Form

Recurring Dependent Daycare Reimbursement Form

Benefits MasterCard Agreement

HRA

Health Reimbursement Arrangement Claim Form

Benefits MasterCard Agreement

Proficient Connect

Proficient Connect Mobile App Guide

Proficient Connect Portal Guide