Forms & Resources

EMPLOYEE ENROLLMENT FORMS & TOOLS

MyAmeriflex Registration Instructions

How To Use Your MyAmeriflex Card

How To Use Your MyAmeriflex Card (Spanish)

5-Step Substantiation Process for card transactions

Customized Enrollment Form

CRA Online Enrollment Instructions

FSA Online Enrollment Instructions

HSA Enrollment Form

HSA Presentation

EMPLOYEE TOOLS

Claim Form

Claim Form (Spanish)

CRA Change of Election Form

Employee Request for Service

Estimate Your FSA Contributions Worksheet

HRA Activation Form

Letter of Medical Necessity

Substantiation Request Form

Substantiation Request Form (Spanish)

Ameriflex Simple Substantiation Video

Orthodontia Form

Refund Request

COBRA FORMS

COBRA Open Enrollment Form

COBRA Participant Recurring ACH Form

COBRA Qualifying Event Submission Form

COBRA Request for Service Form

COBRA Participant Portal Demonstration Video

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