Forms and Resources For Participants

---

Forms & Resources - All Other Locations

Enrollment Materials

• Enrollment/Direct Deposit Form (PDF)
• Flex Worksheet with Examples of Eligible/Ineligible Expenses (PDF)
• Participant Savings Example (PDF)
• Over-the-Counter Drug List (PDF)

Forms to manage your account

• Direct Deposit Authorization (PDF)
• Reimbursement Request Form (PDF)

Debit Cards

• Card Activation Link

Allows cardholder to activate their card via the web using their cardholderID and zip code

Transportation Reimbursement Form

• Transportation Reimbursement Form

Other Resources

• FSA Employee Savings Calculator
• If you have difficulties logging in, please contact Customer Response at 866-370-3040.
• Account information updated each business day between 8:00 p.m. and 12:00 a.m. ET

Did you know ...

You can view your claims, claims paid to date and your account balance. Simply login using your unique user ID.

New Look

You may notice a difference in the information available to you through our website. We can assure you that although your information will look different, your records and information have not changed.

Please use your Social Security Number and Pin Number to login and access your information.

If you have any questions about the information on our website, please contact us at 866-370-3040.