Participant Forms

These materials are for flexible benefits participants who are NOT SEGIP or Minnesota State employees. 

(SEGIP and Minnesota State employees, please find your materials here: SEGIP materials, Minnesota State Materials.)

Enrollment Forms

Flexible Benefits Enrollment

Transit Enrollment Form

Reimbursement FORMS

Reimbursement Request

Transit Account Reimbursement

Change/Termination Forms

Flex Change / Termination Form

Transit Change Form

Request Change in HSA Participation Form

Other Forms

Lost Check Affidavit 

Direct Deposit