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BASIC Flex spreadsheet
Use this spreadsheet for initial group set up or for mid year enrollments. The spreadsheet is pre-protected with a password of BASICFSA. Once completed please name the file your company name and then email to fsaenrollment@basiconline.com.
Download excel spreadsheet BASIC Flex participation information change form
Use this form if an employee has a status change such as an increase in election, change in per pay, termination of coverage or address change.
Online form
Download PDF BASIC Flex document change form
Use this form to make any changes to your plan including benefit coordinator change, plan year change or coverage change.
Download PDF BASIC Flex reimbursement forms
Reimbursement forms BASIC Flex direct deposit form
Click the link below to open the form used to request direct deposit for you BASIC Flex reimbursements.
Fillable PDF BASIC Flex debit card refund form
Participants use this form when they need to refund their employer due to an ineligible debit card charge.
Fillable PDF BASIC Flex enrollment booklet
Click the link below to open the 8 page BASIC Flex enrollment booket.
Download PDF
Download PDF in Spanish BASIC Flex enrollment form
Click the link below to open the enrollment form for BASIC Flex. Do not use this form if you want to sign up for BASIC Flex Limited Purpose or if you have a Health Savings Account (HSA).
Fillable PDF BASIC Flex Limited Purpose enrollment form
Click the link below to open the enrollment form for BASIC Flex Limited Purpose. Use this form if you or your spouse have a Health Savings Account (HSA).
Download PDF BASIC Flex POP
Click the link below to open the enrollment form for BASIC Flex POP (premium only plans).
Employer application
Fillable PDF
Employee enrollment form
Fillable PDF BASIC Flex Self Administration enrollment booklet
This enrollment booklet is only used when an employer acts as the Flex administrator. Do not use this booklet if BASIC handles your plan administration.
Download PDF
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