Forms

Flexible Spending Accounts (FSA/POP) Section 125

• Universal Claim Form
• FSA Enrollment Form
• POP Enrollment Form
• Direct Deposit Form
• Letter of Medical Necessity Form
• Employee Change of Status Form
• FSA Employer Application
• Documents Only Employer Application
• Receipt Form

Healthcare Reimbursement Arrangements (HRA)

• Universal Claim Form
• Direct Deposit Form
• HRA Employer Application

Commuter Benefit Plans Section 132

• Transit Claim Form
• Universal Claim Form (Parking Only)
• Direct Deposit Form
• Section 132 Enrollment Form
• MBTA Enrollment Form
• Section 132 Employer Application
• Bicycle Claim Form
• SmarTrip Enrollment Form
• MBTA Enrollment Form

COBRA Administration

• COBRA Employer Application
• COBRA Rate Renewal Form
• BCBS Carrier TPA Authorization Form
• HPHC Carrier TPA Authorization Form

Healthcare Savings Accounts (HSA)

• HSA Employer Application
• HSA Enrollment Form
• HSA Change of Election Form
• HSA Beneficiary Change/Spousal Consent Form
• HSA Contribution Form
• HSA Distribution Request Form
• HSA Additional Debit Card Request Form
• HSA Death Distribution Request Form

General Information

• Employers Tax Guide
• HIPAA Authorization Form
• Consumer Portal Quickstart Guide

Spanish Resources

• FSA/DCA Enrollment Kit
• FSA/DCA Power Point

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