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COVID-19 Info.
About Us
Our History
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FSA & LPFSA
Dependent Care
HRA
HSA
COBRA
WEX Health Card
Forms / Resources
24/7 Account Access
OTAP Info.
FSA Store / HSA Store
Contact Us/Quote Request
More
Home
COVID-19 Info.
About Us
Our History
Our Team
Services
FSA & LPFSA
Dependent Care
HRA
HSA
COBRA
WEX Health Card
Forms / Resources
24/7 Account Access
OTAP Info.
FSA Store / HSA Store
Contact Us/Quote Request
Home
COVID-19 Info.
About Us
Our History
Our Team
Services
FSA & LPFSA
Dependent Care
HRA
HSA
COBRA
WEX Health Card
Forms / Resources
24/7 Account Access
OTAP Info.
FSA Store / HSA Store
Contact Us/Quote Request
Downloadable Forms & Educational Videos
Direct Deposit Form
(pdf)
Download
FSA Claim Form
(pdf)
Download
Dependent Care Receipt
(pdf)
Download
HRA Claim Form
(pdf)
Download
HSA Contribution form
(pdf)
Download
HSA Distribution Request or Account Closure Form
(pdf)
Download
Letter of Medical Necessity form
(pdf)
Download
Debit Card Substantiation Cover Page
(pdf)
Download
FSA Eligible-Ineligible List
(pdf)
Download
FSA-HRA-HSA Comparison Chart
(pdf)
Download
CARES Act Newly Eligible FSA Items
(pdf)
Download
CARES Act Newly Eligible HSA Items
(pdf)
Download
Educational Videos
Flexible Spending Account (FSA)
Health Savings Account (HSA)
Dependent Care (DEP)
Mobile App Demo
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