Participant Forms & Information

While you can also find most of these items associated with relevant information elsewhere on this site or the portal, here’s a handy list of some useful forms and information for participants, all in one place.

FSA

FSA Enrollment Guide

Using Your FSA Debit Card

Filing an FSA Claim

Medical Mileage Worksheet – 2019
Medical Mileage Worksheet – 2020
Medical Mileage Worksheet – 2021

Dependent Care Receipt Form

Letter of Medical Necessity

Guidance Regarding Reimbursement for Prenatal Care Expenses
Prenatal Provider Letter

HSA

Getting started with your new HSA

Transfer funds from another HSA into your ProBenefits HSA

Transportation Plans (Parking and Transit)

Transportation Plan Summary and Change Form

Claims and Direct Deposit

Reimbursement Claim Form

Direct Deposit Authorization Form

Mobile App

Using the ProBenefits Mobile App

Using the ProBenefits Mobile App With Your HSA

Account Access

Logging in to Your ProBenefits Account for the First Time

Authorization to Share Account Information

Authorization for Disclosure of Protected Health Information