FORMS can be printed, downloaded, completed and faxed or mailed back to us. Address and fax information is provided on each form.

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FSA-Flex Spending Account ENROLLMENT FORMS:

File: FLEX-Enrollment-Authorization Form: This is a generic form, call CPA Inc if you need information on your plan specs

File: FLEX-City of Boston          (custom)                    Enrollment-Authorization Form:

POP-Premium Only Plan Account Forms:

File: POP-Section 125                                  Enrollment-Authorization Form:

FSA-Flex Spending Accounts CLAIM FORM:

File: FLEX-Claim Reimbursement Form:

FSA-Flex Spending Accounts MISCELLANEOUS FORMS:

File: FLEX-Direct Deposit Sign-up Form:

File: FLEX-Dependent Care Certification Form:

File: FLEX-Over-the-Counter Medications List:

File: FLEX-Required Physician's Letter:

HRA-Reimbursement Forms:      (Not for use for FSA FLEX plans)

File: HRA                                                            Generic Claim Reimbursement Form:

File: HRA- Town of Wellesley     (custom)                   Claim Reimbursement Form - 2010:

File: HRA- YMCA-Cape Cod         (custom)                 Claim Reimbursement Form:

File: HRA- Barnstable County        (custom)                Claim Reimbursement Form: