About Our Forms

You deserve fast answers, fast claims, and Web self-service. That's why we've created forms that provide the information you need, and are easy to use and understand.

If you need any assistance contact us 24/7/365 at 877.933.3539.

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General Info


	What is a Cafeteria Plan?
	What is a MERP or HRA?
	What is COBRA?
	Get Free Acrobat Reader
	Contact Us

General Forms

		pdf
	HIPAA Authorization for Release
	Change of Address Mailing Address/Email Address Changes
	Change of Status Form C.O.S. Qualification Matrix www.changeofstatus.com
	Direct Deposit Authorization
	Fax Cover Sheet
	Leave of Absence Form
	Medical Necessity Letter
	Mileage Report
	Over-the-Counter Medical Guidelines
	Claim Form
	IIAS Merchant List Link

Transportation/Mass Transit Forms

		pdf
	Transit Employee Education Flyer
	Transit/Parking Enrollment Form