Forms


Forms

Pharmacy 

Standard reimbursement and mail order pharmacy forms.

Health Savings Account (HSA)

A detailed listing of HSA related forms can be found at Optum Bank sm.

Medical 

Generic reimbusement forms for medical expenses.

Enrollment 

Specific market and group size enrollment forms and employer applications can be found on UnitedeServices. com under the Forms tab.

Health Reimbursement Account (HRA)

Health reimbursement/cash withdrawl form for medical expenses.

Flexible Spending Account (FSA) 

Reimbursement/cash withdraw submission forms for healthcare and dependent care expenses.