Forms & Resources

ADMINISTRATIVE FORMS

FSA CARES Act Over-the-counter Amendment

HRA CARES Act Over-the-counter Amendment

Broker Designation Form

Employee Termination and LOA Form

Employer Request for Service Form

Outside Plan Representative Designation Form

Participant Messaging Options Form

Transaction Reversal Request Form

COBRA FORMS & VIDEOS

COBRA Legacy Qualified Beneficiary Form

COBRA New Plan Member Form

COBRA Qualifying Event Submission Form

COBRA Rate Renewal Request Form

COBRA Special Plan Member Form

COBRA State Continuation Form

COBRA Portal: A Comprehensive Tutorial

COBRA Portal: Adding a Qualified Beneficiary

COBRA Portal: Adding a New Hire

COBRA Portal: Adding a Direct Bill Participant

COBRA Portal: Processing a Qualifying Life Event

COBRA Portal: Running a Remittance Report

COBRA Portal: Running a Member Status Report

Completing the COBRA Legacy Spreadsheet

BANKING FORMS

Funding Change

ENROLLMENT FORMS & TOOLS

Customized Enrollment Form

CRA Online Enrollment Instructions

FSA Online Enrollment Instructions

FSA Enrollment Video

FSA Enrollment Form

FSA Enrollment Form (Spanish)

HRA Enrollment Form

HSA Enrollment Form

HSA Presentation

POP Enrollment Form

Online Enrollment Spreadsheet

Takeover Spreadsheet Template

Upload Spreadsheet

Upload Spreadsheet Instructions

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