| Name | Description | |
|---|---|---|
| Banking Setup Packet | This packet includes everything needed to set up a bank account with EMPOWER. | Download |
| Change in Status | Allows Consumers to change their benefit elections | Download |
| Direct Deposit Authorization Form | Allows Consumers to add or change an existing bank account for direct deposit of reimbursements | Download |
| FSA Claim Form | Use this form to submit an FSA claim. | Download |
| FSA COBRA Form | Use this form to send to terminated Employees to elect COBRA./td> | Download |
| FSA Enrollment Form | Form for Consumers to enroll in FSA. | Download |
| FSA Enrollment Form with Limited | Form for Consumers to enroll in FSA (with Limited FSA option). | Download |
| HRA Claim Form | Use this form to submit an HRA Claim. | Download |
| HSA Beneficiary Form | Use this form to add or change HSA beneficiaries. | Download |
| HSA Claim Form | Use this form to submit an HSA claim. | Download |
| HSA Closure Form | Use this form to close an EMPOWER HSA and return the funds to the Participant. | Download |
| HSA Closure Letter | Example letter to send to employee after HSA account closure due to identity verification failure. | Download |
| HSA Contribution Form | Use this form to make an HSA contribution. | Download |
| HSA Custodial Agreement | All HSA Consumers must either accept the HSA terms on the Consumer portal or sign this form and return the last page to EMPOWER. | Download |
| HSA Enrollment Form | Form for Consumers to enroll in HSA. | Download |
| HSA Investment Options | HSA investment options for consumers | Download |
| HSA Transfer Form | Form for Consumers to transfer their HSA balances from their previous Custodian to their current EMPOWER HSA account. | Download |
| Nondiscrimination Questionnaire | Form for Employers to submit information for nondiscrimination testing. | Download |
| Qualifying Event Form | Change your Plan based on a qualifying event. | Download |
