Please note that
all of our forms are now in HTML and PDF format. The HTML forms
can be filled out then printed; the PDF forms can be printed, then filled out.
We are sincerely sorry for any inconvenience that you may have had with the earlier versions of the Adobe Acrobat forms.
We are excited to introduce an all-inclusive reimbursement claim form for all of your plans with eflexgroup.com. The new claim form will allow us to move to optical character recognition of claims, thereby decreasing claims reimbursement turnaround time. The new form utilizes Adobe Acrobat's fillable forms feature. Once completed, the form should be printed and faxed to eflexgroup.com's claims department at the number listed on the form.
Reimbursement Claim Form
eflex Debit Card Adjudication Form
Mileage Report
Recurring Claims Explanation
Recurring Claims Instructions
Fax Cover Sheet
Direct Deposit Tools
Direct Deposit Authorization
Dependent Care Tools
Dependent Care Worksheet
Dependent Care Contract Form
(Spanish)Dependent Care Contract Form
Form 2441 Dependent Daycare Tax Filing Form
Employee Planning Tools and Resources
FSA Frequently Asked Questions
Flex/HSA Eligible Expense Planning Worksheet
Enrollment Form - Paper
Flex Plan Worksheet
IRS Publication 502 (Expenses for HSA, HRA, Flex)
IRS Publication 503 (Daycare)
Over-the-Counter Medical Guidelines
Spanish Brochure
Transportation Expenses Worksheet
eflex Debit Card Tools
eflex Debit Card Adjudication Form (Card Purchase)
FSA Debit Card Instructions
HSA Debit Card Instructions
eflex Debit Card Lost Receipt Form
Request Additional eflex Debit Card (You will receive your card in 10 days.)