Difference Card Forms

Employer Groups

Banking Forms

• Bank Draft Authorization Form

Enrollment Forms

• Difference Card Enrollment Change Form
• Difference Card Enrollment Census Completion Guide
• Difference Card Enrollment Census Template
• Eligibility Worksheet

Difference Card Forms

• Designated Recipients for Difference Card Correspondence Spreadsheet
• Difference Card Reimbursement Form
• HIPAA Employee Authorization Form
• Online Portal Access Form for Brokers/GA

HSA Forms

• Health Savings Account Enrollment Form
• HSA Employer Contribution Error Form_WealthCare Saver

FSA Forms

• FSA Enrollment Form

Benefit Administration Forms

• Implementation Workbook
• Cobra File Specs
• Vendor File Specs

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