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HSA Forms

the evolution of health and dental benefits ©

Cost-effective Health and Dental Benefits

Assureflex is the best way to transfer Income Tax Free funds for Health and Dental Care. Assureflex Health Spending Accounts provide benefits to obtain and maintain physical and mental health. All Participant and Dependent benefits are non-taxable.

Forms and Documents

Application

Application and Agreement

Health Spending Account Enrollment Form

Electronic Payment Consent Form

Need Assistance in Completing A Form?

Call: (519) 245-3283 or email your questions to: mailroom@assureflex.com

Employer Forms

Online Claim Submission Form

Enrollment and Change Form

Addition of another Benefit Class

Employee Forms

Online Claim Submission Form

Health Spending Account Claims Form

Change of Information Form

Electronic Payment Consent Form

Benefit Booklets

Example of Employee Health Spending Account Benefit Booklet

Example of Executive Health Spending Account Benefit Booklet

note: Actual Booklets show selections made in the Application

Consulting

Tax Act and CRA Rules

General Information