Looking for information on how to file a claim or how your FSA carryover works? Wanting to transfer funds into your NueSynergy HSA or learn about your investment options? Exploring how to establish an FSA, HSA, or HRA plan for your group?We’ve got a form or guide for that and more. Take a look at our list of forms and guides that our participants and employer partners have found helpful.
Not finding the information that you need? Contact our team to get the answers you need.
|Adoption Assistance Employee Guide||
Employee education and FAQs for the Adoption Assistance benefit account.
|Bank to Bank HSA Rollover Form||
To move funds from a Health Savings Account with another administrator and deposit them into your NueSynergy HSA.
|Combined Billing: A Brief Overview||
This flyer/infographic provides a brief overview of Combined Billing and how it works.
|Commuter Benefits Claims Form||
Commuter Benefits claim reimbursement form for eligible mass transportation and parking expenses.
|Dependent Care Eligible Expenses||
List of eligible expenses for the Dependent Care FSA.
|Direct Deposit Setup Form||
Direct deposit setup form for FSA and HRA reimbursement.
|eClaims Manager Setup||
eClaims Manager provides access to an employee’s claims data or explanation of benefits (EOBs), allowing increased auto-substantiation of debit card claims and easier electronic manual claim submission.
|Employee Commuter Benefit Guide||
Employee guide to parking and transportaion pre-tax benefit accounts.
|Employee Dependent Care FSA Handout||
Employee educational handout and account access guide for the Dependent Care FSA.
|Employee FSA Handout||
Employee educational handout with list of eligible expenses.
|Employee HSA Handout||
Employee educational handout with list of eligible expenses.
|Employee Status Change Form||
Employee status change form for qualifying event election changes.
|Employer HSA Guide||
An Employer's guide to Health Savings Accounts. (i.e. Contribution Limits, Eligibility, Benefits, FAQs, etc.)
|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||
A list of FAQs for employer's considering the carryover option for their Healthcare and Limited Purpose FSA plans.
|FSA Carryover Guide||
$500 Carry-over guide for both the Healthcare and Limited Purpose Flexible Spending Accounts.
|FSA Carryover Participant FAQs||
A list of FAQs for participants who have the carryover feature for their Healthcare or Limited Purpose FSA plan.
|FSA Claim Form||
Flexible Spending Account claim reimbursement form for Healthcare, Limited Purpose, and Dependent claims.
|HRA Claim Reimbursement Form||
Health Reimbursement Arrangement claim form.
|HRA Provider Pay Claim Form||
For HRA plans that require claim payments be made directly to the provider.
|HSA Account Maintenance Form||
To update your Health Savings Account (HSA) due to a name, phone or address change. Also update, add, or revoke an additonal signer to your HSA.
|HSA Authorized Signer Form||
Additional signer designation for the Health Savings Account.
|HSA Contribution Correction Form||
This form allows you to correct a contribution made in error, contributions made while not being eligible or a contribution over the allowed maximum.
|HSA Distribution Reversal Form||
To correct a distribution made in error or for an incorrect amount from your Health Savings Account.
|HSA Eligible Expenses||
A list of eligible expenses for the Health Savings Account.
|HSA Participant Guide||
A participant overview of the Health Savings Account (i.e. contribution limits, eligbile expenses, tax benefits, etc.)
|HSA, FSA, and HRA Comparison Guide_2019||
A side-by-side comparison of the Health Savings Account, Flexible Spending Account, and Health Reimbursement Arrangement.
|HSA-HRA Administrator FAQ||sehp_new_hsa-hra_administrator_faq-employee.pdf|
|Individual HSA Contribution Form||
Complete this form if making HSA contributions via check.
|Information Authorization Release Form||
Release form enabling you to designate individuals that you authorize NueSynergy to release information to related to your benefit account.
|Limited Purpose FSA Eligible Expenses||
List of eligible expenses for the Limited Purpose Flexible Spending Account.
|Member Portal Direct Deposit Setup Guide||
Guide to setting up direct deposit for reimbursement through the Member Portal.
|NueSynergy Benefit Card Reimbursement Purse||
A debit card feature allowing for reimbursed funds to be credited to a special reimbursement purse linked to the NueSynergy benefit debit card. Improving the reimbursement process for those that normally recieve checks.
|NueSynergy Benefit Debit Card FAQs||
NueSynergy benefit debit card FAQs and transaction substantiation guide.
|NueSynergy Benefits Debit Card Enrollment Form||
For a participant wanting to order a debit card for their self or any eligible dependents.
|Online Claim Guide||
This guide provides you with step by step instructions on how to submit a claim online.
|Online Direct Deposit Setup Guide||
Step by step instructions for setting up direct deposit online for claim reimbursement.
Medical and dental expenses.
IRS guidelines for HSAs and other tax favored plans.
|Sample FSA Implementation Timeline||
Sample FSA implementation timeline for both the intitial plan setup and transition from a current administrator.
|Sample HRA Implemetation Timeline||
Sample HRA implementation timeline for both the intitial plan setup and transition from a current administrator.
|Sample HSA Employee Payroll Deferral Form||
Sample employee payroll deferral form for the Health Savings Account.
|Sample HSA Implemetation Timeline||
Sample HSA implementation timeline for both the initial account setup and transition from a current administrator.
|Sample Letter of Medical Necessity||
An example of the information needed within a Letter of Medical Necessity.