• (616) 456 - 7908
  • Toll Free: 1 (800) 968 - 3539
  • service@flexadministrators.com
  • Mon - Fri: 8:30 - 5:00 EST
  • Home
    • Contact Us
  • Participants
    • How to Use an FSA
    • FAQ
    • Eligible Expenses
    • Mobile App
    • Forms
  • Employer Information
    • FSA
      • Change of Status for Administrators
      • Flex Plan Calculators
    • HSA
    • HRA/MRA
      • QSEHRA
    • COBRA
      • COBRA Grace Period Extensions
      • Employer COBRA Form
      • COBRA RATE RENEWAL QUESTIONNAIRE
      • Health FSA COBRA Premium Calculator
    • Premium Only Plan
    • Document only
    • Employer Forms
    • Employer Proposal Request
  • Brokers
    • Broker/Agent Proposal Request Form
  • About Us
  • Home
    • Contact Us
  • Participants
    • How to Use an FSA
    • FAQ
    • Eligible Expenses
    • Mobile App
    • Forms
  • Employer Information
    • FSA
      • Change of Status for Administrators
      • Flex Plan Calculators
    • HSA
    • HRA/MRA
      • QSEHRA
    • COBRA
      • COBRA Grace Period Extensions
      • Employer COBRA Form
      • COBRA RATE RENEWAL QUESTIONNAIRE
      • Health FSA COBRA Premium Calculator
    • Premium Only Plan
    • Document only
    • Employer Forms
    • Employer Proposal Request
  • Brokers
    • Broker/Agent Proposal Request Form
  • About Us

FSA Forms

  • Mandatory Statement For Dependent Care
  • Dependent Care Tax Credit Worksheet
  • Reimbursement Form
  • Direct Deposit Authorization Form
  • HIPAA Authorization Form
  • Letter of Medical Necessity

HRA Forms

  • Request for Reimbursement Form
  • HIPAA Authorization Form

HSA Forms

  • HSA Transfer request form

Contact us

Toll Free: 1-800-968-3539

Local: (616) 456-7908

Fax: (616) 454-6090

our office

3980 Chicago Drive, Suite 230 Grandville, MI 49418


hours

Mon – Fri : 8:30 AM – 5:00 PM

Our office is fully remote on Friday, so please make a visit between Monday and Thursday.