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Setup Forms


Flexible Spending Accounts

Flexible Spending Accounts are allowed special treatment under section 125 of the Internal Revenue Code, Which allows employees a choice between tax-free benefits and cash compensation. Commonly referred to as Cafeteria Plans, Section 125 Plans, POP (premium only) and FSA plans, these plans allow employees to use pre-tax dollars to pay for certain qualified expenses.

Premium Only Plan (POP) Compliance Subscription

Premium Only Plane
POP Client Information Form (PDF)

Set up Flexible Spending Account Plan (FSA)

FSA Client Information Form (PDF)
FSA & Commuter Client Information Form (PDF)
FSA & HRA Client Information Form (PDF)
FSA & HRA & Commuter Client Information Form (PDF)


Health Reimbursement Arrangements

Health Reimbursement Arrangements are employer-funded accounts with the flexibility to customize designs and usage. When combined with group health plans, HRAs are a powerful tool for rewarding and encouraging healthy decisions and behaviors, while keeping premiums costs under control.

HRA Client Information Form (PDF)
HRA & FSA Client Information Form (PDF)
Excepted Benefit (EBHRA) - Client Information Form (PDF)
Individual Coverage HRA (ICHRA) Client Information Form
Lifestyle Accounts


Health Savings Accounts

Health Savings Accounts are employee-owned, tax-favored savings accounts with a qualifying High Deductible Health Plan (HDHP) allowing payment for qualifying healthcare expenses with tax-free dollars.

WealthCare Saver HSA

WealthCare Saver HSA Client Information Form (PDF)
HSA Funding Spreadsheet

Avidia Bank HSA

Avidia Bank HSA Client Information Form
HSA Funding Spreadsheet


COBRA & Direct Premium Billing

COBRA & Direct Premium Billing can be difficult to administer. Just keeping up with the rules and regulations can be a full-time job, and that’s why you should check out American Benefits Group. We make it easy so you can focus on other important tasks.

COBRA Client Information Form


Commuter Transit & Parking Benefits

Section 132 Qualified Transportation Fringe Benefits allow employees (or employers) to pay for commuter transit and parking benefits such as transit passes, commuter highway van pool expenses and qualified parking expenses with pre-tax dollars.

Commuter Client Information Form

Consultants: Benefit Offering or Plan