Claims & Admin Forms
Claims and Administration Forms
American Benefit Services is pleased to provide you with these forms to help you with your accounts with us. Please let us know if there are any other forms you might need.

General Forms

Health Savings Account (HSA) Forms

Health Reimbursement Arrangement (HRA) Forms

Flexible Spending Account (FSA) Forms

COBRA Forms

 

All forms are in PDF (portable document format). To view a PDF file you must have the Adobe Reader. If you do not have the Adobe Reader installed on you computer, please download it from the Adobe Reader web site.

 





Health Saving Accounts (HSA) Administration

Effective January 2004, Congress passed legislation for HSAs for individuals participating in high deductible health insurance plans. This account is designed to allow individuals to contribute either the amount of the health plans annual deductible or up to $2850 (2007, $2900 - 2008). This account can be used similar to an FSA or HRA to reimburse individuals for unreimbursed health plan costs. The main differences with this type of account are that both the employer and the employee can contribute to this account, and that the account is portable for the employee. Administration of these plans will be very similar to both FSA and HRA accounts.


 
Health Reimbursement Arrangements (HRA) Administration

 

  • Expert plan design, including Summary Plan Description
  • Coordination with other benefits, including high deductible plans and FSAs
  • Critical nondiscrimination testing
  • Claims processing & monthly reimbursement
  • Year-to-date reports to employer
  • 24/7 web-based participant account information
  • IRS Form 5500 preparation, if needed

 
Flexible Spending Accounts (FSA) Administration

 

  • Plan Document Preparation / Amendment for filing with Department Of Labor
  • Corporate Resolution Adopting / Amending Plan
  • Discrimination Testing (both initial and interim year)
  • Custom Forms
  • Computer Setup, Eligibility Entry
  • Flexible Spending Claims Payment
  • Recordkeeping and Reporting
  • Signature-Ready Form 5500 Preparation, if needed
  • Accounting Functions as Required by the Plan
  • Continued Administrative Support for Employer and Employees
  • 24 Hour Account Info Access via the internet

 


 
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