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Flexible Spending Account Forms Employer Applications Premium Only Plan Application  (174KB) Reimbursement Account Flexible Benefits Employer Application  (462KB) Reimbursement Account Flexible Benefits Employer Application including Flex Debit Card  (323KB) COBRA Continuation Election for Medical Reimbursement Accounts  (148KB) Health Reimbursement Account (HRA) Employer Application  (283KB) Health Reimbursement Account Employer Application including Flex Debit Card  (339KB)

Enrollment Forms

• Pre-Tax Premium Payments Mandatory Enrollment Form #H-8707  (98KB)
• Pre-Tax Premium Payments Non-Mandatory #H-8711  (110KB)
• Employee Reimbursement Account & Pre-Tax Premium Payment Mandatory Combination #H-8754  (122KB)
• Employee Reimbursement Account & Pre-Tax Premium Payment Mandatory with Debit Card Authorization #H-8772  (238KB)
• Employee Reimbursement Account & Pre-Tax Premium Payment Non-Mandatory Combination #H-8757  (122KB)
• Employee Reimbursement Account & Non-Mandatory Pre-Tax Premium Payment with Debit Card Authorization #H-8774  (250KB)
• Pre-Tax Premium Payments and Employee Reimbursement Accounts Change Form #H-8764  (135KB)
• Health Reimbursement Account #H-8767  (222KB)
• Health Reimbursement Account with Debit Card Authorization #H-8382 
   (143KB)

Administrative Forms for Employees

• View and download employee flex forms

Educational Materials

• Order Blue Priority Flex^SM member education materials on the Employer Toolkit