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888.677.8373
  • Home
  • Participants
    ▼
    • Participant Login
    • Participant Learning Center
    • Forms & Brochures
  • Employers
    ▼
    • Employer Login
    • Employers Learning Center
    • Services
      ▼
      • FSA
      • HRA
      • HSA
      • POP
      • ERISA Wrap/SPD
      • Form 5500 Filing
      • COBRA
    • Forms & Brochures
  • About Us
  • Contact Us
  • Secure File Upload

Forms & Brochures

All forms are in PDF format. Click here to download Adobe PDF Reader.

FSA

  • General Claim Form
  • Dependent Care Claim Form
  • Direct Deposit Form
  • HIPAA Authorization Form

HRA

  • General Claim Form
  • Direct Deposit Form
  • HIPAA Authorization Form


HSA

  • How much can I contribute?
  • Contribution Grid for Spouses
  • Qualifying HSA Expenses
  • HSAs & How to Use
  • IRA Transfers & HSAs
  • Form 8889
  • Instructions for Form 8889
  • Publication 969
  • Form 1099-SA
  • Form 5498-SA
  • Instructions for Forms 1099-SA and 5498-SA
  • Instructions for Forms 1099-SA and 5498-SA

FSA Store

Shop for FSA-Eligible Products

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Check Balances, Submit a Claim + more!

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Upload your paperwork / applications to FlexBank

Contact Us

Visit our contact page for our phone number & online form.

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FlexBank|Navia Contact Information

Phone: 888.677.8373
Phone: 937.299.5515

 

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