

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
Reimbursement FORMS
Change/Termination Forms
Flex Change / Termination Form
Transit Change Form
If you are an employee/participant with Hennepin Healthcare Systems, do not use this form. Login to employee self-service and click on Employee Benefits tile. Choose life events/all other life events/transportation FSA changes. Enter the date and complete the process or contact your enrollment vendor at 877-558-1177.
Request Change in HSA Participation Form