Forms & Handouts
2023 Forms
For use through the 2023 plan year ending 12/31/2023.
2023 FSA forms may be used through WEX until runout period of 3/31/2024. 2024 FSA administration will be in Benefitsolver using MyChoice Accounts.
2023 Family Status Change Form can be used until 12/31/2023. Starting 1/1/2024 submit family status changes in Benefitsolver.
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Family Status Change Form
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BCBSM Member Reimbursement Form
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FSA Out-of-Pocket Reimbursement Request Form
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COBRA Member Handout
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2023 COBRA Rates
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Reliance Standard Life Beneficiary Form
2024 Forms
For use in the 2024 plan starting 1/1/2024. Many benefit form submissions now take place in Benefitsolver.