Forms
Flexible Spending Account (FSA) Resources:
- Claim Form (Can be signed/submitted online) | **Securely Upload Your Claim **
- Eligible FSA Expenses: with 2011 Over-the-Counter (OTC) Changes
- Fillable Dependent Care Receipt
- Letter of Medical Necessity (for supplements, medications, services not normally qualified)
- Over-the-Counter (OTC) Prescription Template (OTC drugs or medicines, do not need a medical condition)
- 24HourFlex Card Guide
- Direct Deposit Request Form (Can be added through your online account under User Info and then Direct Deposit tabs)
- Approved Daycare Expenses
- IIAS Approved Merchants List (external site, left side under “publications”)
Health Savings Account (HSA) Resources:
- My HSA Account Guide (Explains how to access HSA funds)
- HSA Introduction/Overview
- HSA Login Instructions
- HSA Account Application
- HSA Transfer and Rollover Request Form
COBRA Resources:
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