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
Medical Mileage Worksheet – 2019
Medical Mileage Worksheet – 2020
Medical Mileage Worksheet – 2021
Medical Mileage Worksheet – 1/1/22-6/30/22
Medical Mileage Worksheet – 7/1/22-12/31/22
Guidance Regarding Reimbursement for Prenatal Care Expenses
Video: What is an FSA and How Does it Work?
Video: What is a Dependent Care FSA?
HSA
Getting started with your new HSA
Introducción a su nueva HSA (Getting started with your new HSA – Spanish version)
Transfer funds from another HSA into your ProBenefits HSA
Video: Why Should I Get an HSA?
Transportation Plans (Parking and Transit)
Transportation Plan Summary and Change Form
Claims and Direct Deposit
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