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Welcome to BASIC

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.

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 Reimbursement Form (Non Debit Card Users)

Employees who do NOT have a BASIC HRA Debit Card use this form to request reimbursement from their BASIC HRA account.


BASIC HRA Benefits Card Reimbursement/Verification Form
(HRA Debit Card Users)

Employees with a BASIC HRA Debit Card use this form to request reimbursement from their BASIC HRA account or to submit verification for card transactions.


BASIC Flex 1Direct Reimbursement Form (Flex 1Direct Users)


BASIC Flex/BASIC HRA Reimbursement Form (Flex /HRA Users)

Employees that have both a BASIC Flex and BASIC HRA plan use this form to request reimbursements.