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Forms — Health Care Reimbursement Account Plan

(NOTE: On-line documents are in Portable Document Format (PDF) and
require Adobe Acrobat Reader to view, unless otherwise noted.)
 
  • Enrollment Authorization Form- Paper Version
  • Enrollment Authorization Form - Fill and Print Version
    •  
  • DCRA/HCRA Combined Claim Form
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  • HCRA Direct Pay Form

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  • HIPAA Authorization Form
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  • HIPAA Privacy Notice

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    Last Updated: November 17, 2011
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