Welcome to BASIC

Below you will find a variety of claim forms due to the different plans we have available. Please read the description of each to find the appropriate claim form for your plan. If you have a question on which form you should use please call one of our customer service representatives at 888-472-0777.

BASIC HRA debit card refund form

Click to open the form used when you need to refund your employer due to an ineligible debit card charge.

BASIC HRA reimbursement forms