Frequently Used Forms

Use this form to submit a reimbursement to HSAccess Card. Download
Use this form to submit your FSA reimbursement to HSAccess Card. Download
Use this form to submit your Dependent Care reimbursement to the HSAccess Card. Download
HSAccess Card must obtain authorization before using or disclosing protected health information (PHI). Download
This letter is used to assist you and your healthcare provider in providing the information needed to process a claim. Download
Use this worksheet to help determine your annual healthcare contributions for the upcoming plan year. Download
View a complete list of thousands of products that are FSA eligible and can be purchased through your HSAccess Card. View List
Download and complete this form to earn points for your Annual Physical Exam. Download
Download and complete this form to earn points for regular physical activity. Once completed, submit it to the HSAccess Card. Download
If you attended a Live Wellness Webinar, complete this form and send it to the HSAccess Card to receive your wellness points. Download



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