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Advanced Flex Plan Administration with the Human Touch
Participant Resources for all Benefits
This page provides you with all forms and instructional guides for your EMPOWER Plan.
This page shows resources for all benefits. If you wish to view only the resources for your Plan, click the appropriate button below.
Table of Contents
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.
HRA Claim Form
Use this form to submit an HRA claim.
HSA Beneficiary Form
HSA Claim Form
Use this form to submit an HSA claim.
HSA Contribution Change Form
Use this form to make a change to your HSA contributions.
HSA Contribution Form
Use this form to make an HSA contribution outside of your Employer’s payroll.
HSA Custodial Agreement
All HSA participants must either accept the HSA terms on the Consumer portal or sign this form and return the last page to EMPOWER.
HSA Transfer Form
Form to transfer the balance from another account to your current EMPOWER HSA account.
List of eligible items for all plans.
HSA Investment Options
List of HSA investment options.
Instructional Guides and Tutorials
FSA Welcome Guide (PDF)
Comprehensive guide to using your EMPOWER FSA.
FSA Welcome Page (Online)
Comprehensive online guide to using your EMPOWER FSA.
HRA Plan Fact Sheet (PDF)
Details the plan-specific details of your HRA.
HRA Welcome Page (Online)
Online guide to using your EMPOWER HRA.
HSA Welcome Guide (PDF)
Comprehensive guide to using your EMPOWER HSA.
HSA Welcome Page (Online)
Comprehensive online guide to using your EMPOWER HSA.
Online Portal Quick Start Guide for FSA and HRA
Learn how to use the Online Portal (FSA and HRA).
Online Portal Quick Start Guide for HSA
Learn how to use the Online Portal (HSA).