Flex Benefit Forms

Authorization Forms

• Direct Deposit Authorization Form - Rapid City, SD Processing
• Direct Deposit Authorization Form - Sioux City, IA Processing

Reimbursement Forms

• Request For Reimbursement Form - Rapid City, SD Processing
• Request For Reimbursement Form - Sioux City, IA Processing
• Dependent Care Receipt Form
• Medical Necessity Form
• Orthodontic Payment Form
• Mileage Log Effective 1/1/2010