Forms Online HRA Employer

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  • All forms are in Adobe .pdf format.
  • Click on the form you want below. A separate window will open with the selected form displayed.
  • Either print the form or save a copy to your computer.

You may save these to your hard drive, then print the form(s) and distribute as needed.

NOTE: Enrollment forms come in many varieties. We have posted one below that will fit most employers’ needs. Please contact FlexBank should your combination of benefit offerings require a special format.

HRA Enrollment/Termination Form
HRA Employee Eligibility Form

Direct Deposit Form
Direct Deposit Authorization