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BASIC HRA participant 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. Type directly in the fillable PDF to ensure legibility.
Fillable PDF BASIC HRA spreadsheet
Use this spreadsheet for initial group set up or for mid year enrollments. The spreadsheet is pre-protected with a password of BASICHRA. Once completed please name the file your company name and then email to hraenrollment@basiconline.com.
Download excel spreadsheet BASIC HRA document change form
Use this form to make any changes to your plan including benefit coordinator change, plan year change or coverage change. Type directly in the fillable PDF to ensure legibility.
Fillable PDF BASIC HRA new participant enrollment form
Use this form to add a new participant to your HRA plan. Type directly in the fillable PDF to ensure legibility. Don't forget to have the employee sign the enrollment form before faxing.
Fillable PDF BASIC HRA 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 HRA claim forms
Claim forms BASIC HRA direct deposit form
Click the link below to open the form used to request direct deposit for your BASIC HRA reimbursements
fillable PDF
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