Forms and Info

Use the Adobe Acrobat Reader to view and print these forms

Helpful Reimbursement Account Information

• List of Eligible Medical Flexible Spending Account Items
• Tax Savings Brochure
• Qualifying Individual/Child Guide

Flexible Spending Account Reimbursement Request Forms

• Medical FSA
• Dependent Care FSA
• Parking Reimbursement Account

Flex Debit Card Materials

• What You Need to Know About Your Flex Debit Card
• Flex Debit Card Refund Form
• Flex Debit Card PIN Number FAQ

HRA Reimbursement Request Forms

• HRA Reimbursement Request

Customized Reimbursement Request Forms

• Boston College Pay-The-Provider Request Form
• Children's Hospital Tuition Assistance Application and Checklist
• Harvard University General Tuition Assistance Plan Form
• Harvard University HUCTW Tuition Assistance Plan Form
• Harvard University Service and Trade Unions Tuition Assistance Plan Form

Direct Deposit Authorization

• Direct Deposit Authorization Form
• Direct Deposit Q & A

ACH Withdrawal Authorization (For Cobra / Billing Premiums)

• Standard (Not: Harvard, Delta or Sun Life) ACH Q & A and Authorization Form
• Delta Dental ACH Q & A and Authorization Form
• Harvard University ACH Q & A and Authorization Form
• Sun Life ACH Q & A and Authorization Form

HIPAA

• Crosby HIPAA Authorization

If you would like to obtain other forms, or require assistance, please contact us:
Email: servicecenter@crosbybenefits.com
Phone: 800-462-2235
Fax: 617-928-0001