BASIC Flex Claim Forms
BASIC is pleased to announce a new process for the submission of claims and verifications.
We have created a secure claim upload portal for claim/verification submission. This new process allows you to complete a reimbursement request or verification form, attach documentation and receive confirmation that your submission was successfully uploaded. Please submit your reimbursement/verification request here.
BASIC Flex Reimbursement Form
Employees who do NOT have a BASIC HRA Debit Card use this form to request reimbursement from their BASIC Flex account.
Non Debit Card Users (pdf)
BASIC Flex Benefits Card Reimbursement/Verification Form
Employees with a BASIC Flex Debit Card use this form to request reimbursement from their BASIC Flex account or to submit verification for card transactions.
Flex Debit Card Users (pdf)
BASIC Flex/BASIC HRA Reimbursement Form
Employees that have both a BASIC Flex and BASIC HRA plan use this form to request reimbursements.
Flex /HRA Users (pdf)