Use this form when:

New Hire - Electing a medical or dependent care flexible spending account

Qualifying Status Change - Change in daycare

This form is not used during Open Enrollment.  Online enrollment required annually.

Claims are administered by HealthPartners for claims status and specific questions contact HealthPartners.com or 952.883.5000

Use this form to opt out of automatic medical flexible spending reimbursement.  All reimbursements from your FSA will be a manual process.  For further information contact HealthPartners.com or 952.883.5000

Use this form to start, stop or change direct deposits into your bank account.  For further information contact HealthPartners.com or 952.883.5000