EMPOWER

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Advanced Flex Plan Administration with the Human Touch

Participant Resources for FSA

This page provides you with all forms and instructional guides for your EMPOWER FSA Plan.

Table of Contents

Forms

EMPOWER encourages you to use the Online Portal to ensure the fastest service (see the Instructional Guides and Tutorials section below for more information). However, forms are provided below for you to fill out and return to EMPOWER as an alternate way to use your benefits.

Change in Status/Qualifying Event Form

Required for mid-year changes to your FSA

Direct Deposit Authorization Form

Add or change an existing bank account to receive reimbursements right to your bank account

FSA Claim Form

Use this form to submit an FSA claim.

Additional Resources

Eligible Items

List of eligible items for all plans.

Instructional Guides and Tutorials

FSA Welcome Guide

Comprehensive guide to using your EMPOWER FSA.

FSA Welcome Page (Online)

Comprehensive online guide to using your EMPOWER FSA.

Online Portal Quick Start Guide

Learn how to use the Online Portal.

EMPOWER Participant
Mobile App Download

If you have an FSA, HRA, or HSA with EMPOWER, we encourage you to
download the Mobile App to manage your benefits on the go!
Apple iOS
Google Android

EMPOWER LOGIN

I am a Participant
Click the above link if you are a participant who has an FSA, HSA, or HRA with EMPOWER.
I am an Employer
Click the above link if you are an Employer or Consultant.

Download Forms

Click one of the links below to view the available forms.

I am a Participant
Click the above link if you are a participant who has an FSA, HSA, or HRA with EMPOWER.
I am an Employer
Click the above link if you are an Employer or Consultant.