HR Concepts, LLC

THIRD PARTY ADMINISTRATION

BENEFIT CONSULTING & MANAGEMENT

STRATEGIC PARTNERS (PAYROLL, ATTORNEY, HR)


FSA Claim Form Healthcare Worksheet Daycare Worksheet FSA Education Sheet FSA Enrollment Form POP Enrollment Form List of Eligible Medical Expenses List of Eligible Daycare Expenses Direct Deposit Form	(TPA) Takeover Letter (EE) Change of Status Form (ER) Change of Status Form FSA Quote Payroll Report Over the Counter List FSA Employer Application Receipt Submission Form

Claim Form Direct Deposit Form 132 Enrollment Form	132 Quote 132 Employer Application

Notification Form Carrier Notice Letter COBRA Employer Application	(TPA) Takeover Letter COBRA Quote

HRA Claim Form Receipt Submission Form HRA Education Sheet	HRA Quote HRA Employer Application Direct Deposit Form

Claim Form DR Enrollment Form	DR Employer Application Direct Deposit Form

*Please note these forms are provided in a PDF format. You will need to have Adobe Acrobat Reader installed on your computer. Use the button at the left to download Acrobat Reader and obtain additional information.

Section 125 · Cobra · Healthcare Reimbursement Accounts · Partial Self-Funding Programs ·
Streamline Billing · Section 132 · Dental Reimbursement · Benefit Administration

| | |

| |

|

| | | |

| |

| |

| | |