Forms & DocumentsAccess claim forms, account documents, and benefit resources all in one convenient place.

Find the forms you need—quickly and easily.

Whether you’re submitting a claim, updating your account information, or managing your benefits, you’ll find the forms and documents you need right here.

Simply choose the category below to get started. If you’re not sure which form you need, our Member Care team is happy to help.

Participant Forms

Use these forms to manage your benefit accounts and submit requests.

Flexible Spending Account (FSA)

• DCAP Claim Form
• FSA Claim Form
• FSA HRA Combo Claim Form

Health Savings Account (HSA)

• HSA Transfer Form
• HSA Transfer Form Due to Divorce
• HSA Distribution of Excess Contribution Form
• HSA Beneficiary Form
• HSA Account Closure Form
• HSA Death Distribution Form
• HSA Contribution Form

Health Reimbursement Arrangement (HRA)

• HRA Claim Form
• Funded HRA Claim Form
• FSA HRA Combo Claim Form

VEBA

• Idaho VEBA Group Claim Form
• Funded HRA Claim Form

Parking & Commuter Benefits

• Parking and Mass Transit Claim Form

Before You Submit a Claim

To help us process your request as quickly as possible, please remember to:

• Complete all required fields.
• Sign the form (if required).
• Include any supporting documentation, such as receipts or an Explanation of Benefits (EOB).
• Review the instructions before submitting your request.

Incomplete forms may delay processing.

Need Help Finding the Right Form?

Not sure which form you need or have questions about completing it?

Our knowledgeable Member Care team is here to help. We’ll make sure you have the right form and understand exactly what information is needed before you submit it.

Contact Member Care