Forms and Guides
Downloadable for your convenience.
Adoption Assistance Employee Guide
Employee education and FAQs for the Adoption Assistance benefit account.
Combined Billing: A Brief Overview
This flyer/infographic provides a brief overview of Combined Billing and how it works.
Commuter Benefits Claims Form
Dependent Care Eligible Expenses
List of eligible expenses for a Dependent Care FSA.
Direct Deposit Setup Form
eClaims Manager Setup
Eligible Reimbursements and Travel Expenses for Abortion
This form details where women can find appropriate abortion care; such as employee benefits, travel reimbursements, travel expenses and more.
Employee Commuter Benefit Guide
Employee guide to parking and transportation pre-tax benefit accounts.
Employee Dependent Care FSA Handout
Employee FSA Handout
Employee educational handout with list of FSA eligible expenses.
Employee HSA Handout
FSA Beneficiary Designation Form
Beneficiary Designation form for the Flexible Spending Account benefit to designate the individual/s that may have certain obligations and responsibilities to file claims and seek reimbursement under the terms of the plan in the event of your death.
FSA Carryover Employer FAQs
FSA Carryover Participant FAQs
FSA Claim Form
FSA Claim Form (Spanish)
Health Care FSA Employee Guide
How To File An Online Claim Guide
This guide provides you step-by-step instructions on how to submit a claim online.
HRA Claim Reimbursement Form
HRA Provider Pay Claim Form
HSA Eligible Expenses
A list of eligible expenses for a Health Savings Account.
HSA Handout (2022+2023)
An updated guide to Health Savings Accounts. (i.e. Contribution Limits, Eligibility, Benefits, FAQs, etc.)
HSA, FSA, and HRA Comparison Guide
Information Authorization Release Form
IRS Publication 502
Check out the latest IRS 502 Publication document
IRS Publication 969
Limited Purpose FSA Eligible Expenses
List of eligible expenses for a Limited Purpose Flexible Spending Account.
NueSynergy Benefit Debit Card FAQs
NueSynergy benefit debit card FAQs and transaction substantiation guide.
NueSynergy Benefits Debit Card Enrollment Form
Fill out this form if you are a participant wanting to order a debit card for yourself or any eligible dependent(s).
Online Direct Deposit Setup Guide
Sample FSA Implementation Timeline
Sample HRA Implementation Timeline
Sample HRA implementation timeline for both the initial account setup and transition from a current administrator.