Form Downloads

Forms For All Tri-Star Customer Employees

COBRA Forms

Notice of Qualifying Event Form

Notice of Second Qualifying Event Form

Notice of Disability Form

Notice of Other Coverage, Medicare Entitlement or Cessation of Disability Form

Application to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction

All Others

Claim Form - Health Care (HCRA) and Dependent Care (DCRA) Accounts

Claim Form – Limited Purpose Health Care Account (HCRL)

Claim Form - Health Reimbursement Arrangements (HRA)

Claim Form – Pre-Tax Parking & Mass Transit (PARK or TRAN)

Debit Card Lost Card/Additional Card Order Form

Direct Deposit Request Form

Worksheet for Health Care Account (HCRA)

Worksheet for Dependent Care Account (DCRA)

Over The Counter (OTC) Drug List

FSA Qualifying Expenses

Add Employee and Change Form

VOID Check Request Form

HIPAA Release Form

Medical Necessity Form

Specialized Customer Forms

Brand Services

BrandBenefits.net

Fidelity 401(k)

Starbridge FAQs

Flexible Spending Accounts (FSA)

Hospital Sisters Health System

St. Louis Metropolitan Sewer District

Vision Plan Claim Form

Pennsylvania State Education Association (PSEA)

FSA Summary Plan Description

FSA Employee Add/Change Form

IRS Publications

Health Care

IRS Publication 502 (Health Care)

Dependent Care

IRS Publication 503 (Dependent Care)

HSAs and Other Tax-Favored Health Plans

IRS Publication 969 (HSAs and Other Tax-Favored Health Plans)

Other IRS Publications

Other IRS Publications

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