Pretax Plans Forms and Applications

These forms pertain to the implementation and administration of the BeneFLEX products:

Employer Initial Enrollment:

To get started, please provide a completed Intent to Enroll Form and the appropriate enrollment forms will be sent to you.

• BeneFLEX Intent to Enroll Form
• BenenFLEX POP Employer Brochure and Application
• BeneFLEX Enrollment Checklist

Employee General Administration Forms:

• BeneFLEX FSA Employee Brochure and Enrollment Form
• Employee Tax Savings Calculator
• HSA Contribution Change Form
• BeneFLEX Status Change Form
• Direct Deposit Form

Claims Reimbursement Forms:

• BeneFLEX Cafeteria Plan Reimbursement Claim Form
• TMA (Mass Transit/Parking) Reimbursement Claim Form
• Standard HCSO HRA Overview with Direct Deposit & Claim Forms