Here you will find forms pertaining to flexible spending account elections, reimbursements, eligible expenses and more…
- FSA Election Form
- FSA Claim Form
- Continual Reimbursement Form (Dependent Care)
- Direct Deposit Authorization
- Healthcare FSA Eligible Expense Guide
- FSA Participant Login Instructions
Existing Clients: Please complete the appropriate notification form below and submit to your account service representative for immediate action.
New Groups: Please find below the initial setup documents to establish COBRA services through TAG. An administrative agreement will be supplied for endorsement upon receipt of required company information.
- COBRA Administration Application
- Carrier and Plan Information*
- Current COBRA Participant Takeover Form
- Carrier Authorization Letter*
*Carrier & plan information forms and authorization letters are required for each carrier.
Submit New Group Information:
Your Account Manager will contact you to provide administrative details and a timeline of implementation. For immediate assistance please contact a TAG COBRA specialist.