Consumer-Directed Healthcare Administration Specialists

Library: Forms/Brochures - Employee Information

(DOWNLOAD FREE ADOBE ACROBAT READER HERE)

QUICK LINKS - REIMBURSEMENT FORMS:

HCRA- Medical Reimbursement (PDF)

HCRA- Medical Reimbursement (MS Word)

DCRA- Dependent Daycare Reimbursement

DCRA- Dependent Daycare Reimbursement (MS Word)

FSA ACCOUNTS: HCRA (Medical) and DCRA (Dependent Daycare)

FSA BROCHURES AND GENERAL INFO:

BROCHURE: CDH - MGIS Consumer Directed Healthcare- all your CDH needs in one place.

BROCHURE: FSAs - Flexible Spending Accounts For Your Out-Of-Pocket Health Care Expenses

FOLLETO: FSAs - Cuentas de Gastos Flexibles para Sus Gastos de Asistencia Médica de Bolsillo

BROCHURE: The We-R-CDH Website
FOLLETO: El Sitio web We-R-CDH

BROCHURE: How Your Card Works - The MGIS Benefits Purchasing Card
BROCHURE: Grace Periods for Flexible Spending Accounts
BROCHURE: Direct Deposit General Information
INFO: What can you purchase with the card? Examples of covered items (Eligible and Ineligible FSA-HCRA Expenses)
DIRECT DEPOSIT SET-UP: Online set-up with on-screen help.

FSA: EMPLOYEE ENROLLMENT PACKETS (Paquetes de Matriculación de empleado)

ENROLLMENT: FSA Employee Enrollment Packet (complete)

MATRICULACIÓN: FSA Paquete de Matriculación de empleado (breve)

HCRA: (Medical FSA) - Info and Forms

REIMBURSEMENT: HCRA Medical Reimbursement (FSA-HCRA Medical Reimbursement Request)

ENROLLMENT: FSA Election Form (Medical and/or Dependent Daycare Election Form)

DCRA: (Dependent Daycare FSA) - Info and Forms

BROCHURE: Eligible and Ineligible FSA-DCRA Expenses - What Daycare expenses are eligible?

REIMBURSEMENT: DCRA Dependent DayCare Reimbursement(FSA-DCRA Dependent Care Reimbursement Request)
REIMBURSEMENT: DCRA Dependent Care Reimbursement Request - Electronic (MS Word format Word format - fill out electronically, rather than by hand )

ENROLLMENT: DCRA (Dependent Care) Worksheet
ENROLLMENT: FSA Election Form (Medical and/or Dependent Daycare Election Form)

CBA: (Commuter / Transportation) - Info and Forms

BROCHURE: CBA (Commuter Benefit Account) For Qualified Transportation & Parking

BROCHURE: "Wired Commute" CBA (Online Commuter Benefit Account) For Qualified Transportation & Parking

ENROLLMENT: CBA Information Sheet (Commuter Benefits Account)

REIMBURSEMENT: CBA Commuter Benefits Reimbursement (FSA-CBA Commuter Benefits Account Reimbursement Request)

ENROLLMENT: CBA Election Form (Commuter Benefits Account)

HSA: (Healthcare Savings Account)

BROCHURE: HSA (Healthcare Savings Account)

INFO: Healthcare Savings Account (HSA) Eligible Expenses

HRA: (Health Reimbursement Arrangement - Employer-Sponsored Plan)

BROCHURE: Health Reimbursement Arrangement (HRA) For Employer-Sponsored HRA Accounts

REIMBURSEMENT: HRA (Healthcare Reimbursement Arrangement Reimbursement Request)
REEMBOLSO: HRA (Petición de Reembolso de Arreglo de Reembolso de asistencia sanitaria)
REIMBURSEMENT: HRA (Healthcare Reimbursement Arrangement Reimbursement Request) - Electronic (MS Word format Word format - fill out electronically, rather than by hand )

ENROLLMENT: HRA/FSA Election Form (HCRA, DCRA and HRA)
ENROLLMENT: HRA Election Form (HRA Only)

LPFSA (Limited-Purpose FSA) - Info and Forms

BROCHURE: LPFSA (Limited Purpose FSA)For Health Care Flexible Spending Accounts

INFO: LPFSA Eligible and Ineligible Expenses (Qualified expenses for the LIMITED PURPOSE FSA)

REIMBURSEMENT: LPFSA Reimbursement (Limited Purpose FSA Reimbursement Request)

ENROLLMENT: LPFSA Election Form (Limited Purpose Flexible Spending Account)

PREMIUM REIMBURSEMENT ACCOUNT (PRA) - Info and Forms

BROCHURE: PRA (Premium Reimbursement Account) For Individually-Owned Health Insurance

REIMBURSEMENT: PRA Reimbursement Request Form

ENROLLMENT: PRA Election Form (HCRA, DCRA and PRA: Premium Reimbursement Account)

OTHER FORMS AND PLAN INFORMATION

BROCHURE: HR Essentials

BROCHURE: PCA (Premium Conversion Account) For Your Payroll Deducted Premiums

FORM: HIPPA Authorization form

FORM: Election Change / Change in Status Form

FORM: Card Transaction Receipt Coversheet

FORM: Card Transaction Receipt Coversheet - Electronic (MS Word format Word format - fill out electronically, rather than by hand )

FORM: Additional Card Request