Forms

Direct Deposit form: You may add your personal banking information within your Benefitsolver portal or the MyChoice Mobile App. Alternately, you may submit this form to receive direct deposits for claims. Follow the instructions on the form for submission.

Flexible Spending Accounts

What is a Flexible Spending Account (FSA)?
FSA Forms

Health Savings Accounts

What is a Health Savings Account (HSA)?
HSA Forms

Health Reimbursement Account

What is a Health Reimbursement Account (HRA)?
HRA Form
Retiree HRA: premium-only reimbursement
Retiree HRA: medical + premium reimbursement

Commuter Benefits

What are Commuter Benefits?
Commuter Benefits Form