BASIC Flex reimbursement forms
Reimbursement forms

BASIC Flex direct deposit form
Click the link below to open the form used to request direct deposit for you BASIC Flex reimbursements.
Fillable PDF

BASIC Flex debit card refund form
Click the link below to open the form used when you need to refund your employer due to an ineligible debit card charge.
Fillable PDF

BASIC Flex enrollment booklet
Click the link below to open the 8 page BASIC Flex enrollment booket.
Download PDF
Download PDF in Spanish

BASIC Flex enrollment form
Click the link below to open the enrollment form for BASIC Flex. Do not use this form if you want to sign up for BASIC Flex Limited Purpose or if you have a Health Savings Account (HSA).
Fillable PDF (you must sign and return to your HR department)

BASIC Flex Limited Purpose enrollment form
Click the link below to open the enrollment form for BASIC Flex Limited Purpose. Use this form if you or your spouse have a Health Savings Account (HSA).
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BASIC Flex POP
Click the link below to open the enrollment form for BASIC Flex POP (premium only plans).
Fillable PDF

BASIC Flex Self Administration enrollment booklet
This enrollment booklet is only used when an employer acts as the Flex administrator. Do not use this booklet if BASIC handles your plan administration.
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