Forms

All of the forms necessary for the administration of our plans are listed below. If you can’t find the form you’re looking for, you can click the Contact Us button and a Client Service Representative will be happy to help you.

Enrollment Forms:

• HRA Enrollment Form
• HRA Electronic Enrollment Template
• HRA Takeover Template
• FSA-DCA Enrollment Form
• FSA-DCA Electronic Enrollment Template
• FSA-DCA Takeover Template
• HSA Enrollment Form
• Transit/Parking Enrollment Form 
• Renewal Template
• Premium Only Plan Enrollment Form
• Premium Reimbursement Enrollment Form
• COBRA Enrollment Form

Employee Change Forms:

• Employee Status Change Form
• Employee Name/Address/Email Change Form
• Employee Termination Form  
• HIPAA Release Form - To sign up for our Substantiation Service
  
  • Have questions about this form? Click here for a step by step presentation 

Employer Forms:

• How do I terminate one of my employees from Choice Strategies?
• HRA Letter to Providers
• PPACA Amendment
• Massachusetts Health Care Reform Amendment
• Plan Change Form
• ACH Form
• HSA Deposit Template

Employee Forms:

• Choice Strategies Card Instructions
• All Other Employee Forms

 Spanish Forms:

• HRA Enrollment Form - Spanish
• FSA Enrollment Form - Spanish
• HSA Enrollment Form - Spanish
• Claim Form - Spanish
• HIPAA Release Form - Spanish
• HRA Letter to Providers - Spanish