DOWNLOAD OUR MOST FREQUENTLY REQUESTED FORMS
FLEXIBLE BENEFIT PLAN/SPENDING ACCOUNT FORMS
- Flexible Benefit Enrollment/Change Form
- Flexible Benefit Enrollment/Change Form w/Limited FSA
- Employee Informational Packet
- Employee Packet with Limited Account Info
- FSA Claim Form
- FSA Claim Form with Grace Period
- Orthodontic Services Claim Form
- Qualified Reservist Distribution Form
- HSA Limited FSA Fact Sheet
- 2025 Post Deductible Certification
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) FORMS
- For forms specific to your HRA plan please log into your portal or email us at flex@benefitextras.com
HEALTH SAVINGS ACCOUNT (HSA) FORMS
- HSA Enrollment Form
- HSA Brochure
- HSA Contribution Form
- HSA Name Change Form
- HSA Information Change Notification Form
- HSA Beneficiary Form
- HSA Additional Debit Card Request
- HSA Direct Deposit Form
- HSA Transfer Form
- HSA Information Authorization Form
- HSA Power of Attorney
- HSA Power of Attorney Disability/Incapacity Form
- HSA Death Distribution Form
- HSA Distribution Request/Account Closure
- HSA Commonly Asked Questions & Answers
- HSA Portal Guide
TRANSPORTATION BENEFIT PLAN FORMS
COBRA FORMS
For forms specific to your COBRA administration, please email us at cobra@benefitextras.com.