Allegiance - Flex - Employer Area

The following forms are here for your convenience.
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Enrollment Forms Flex Enrollment with Debit Card Mid-Year Election and Change with Debit Card Flex Enrollment without Debit Card Mid-Year Election and Change without Debit Card Flex Enrollment Form with Employer Contribution Limited FSA Enroll Form Limited Flex Mid-Year Change & Election Form Flex Enrollment Form (Spanish) Premium Reimbursement Enrollment Form Transportation Benefits Enrollment Form Transportation Benefits Enrollment Form with Employer Contributions HRA Enrollment Form HRA Enrollment Form for Dependents	Debit Card Information IIAS Employer Agreement Debit Card Enrollment Form What do I do if my debit card is lost or stolen? Debit Card Tips Why is my card denied? Employer Tips for the Debit Card Sample Card Package	Claim Forms Online Claim Submit Flex Medical Expense Reimbursement Claim Form Limited Flex Medical Expense Reimbursement Claim Form Orthodontic Expense Form Premium Reimbursement Claim Form DayCare Reimbursement Claim Form DayCare Reimbursement Contract Dual Purpose Treatment Policy Dual Purpose Provider Form Medical Mileage Information Mass Transit Claim form Parking Claim form HRA Claim form

Flex Information Flex Advantage Contact List and Flex Examples Spanish Flex Advantage How to complete a W-2 Form What is an Eligible Dependent	Direct Deposit Form Direct Deposit Enrollment Form Find out about Online EOB Notification How do I set up this option on the web? Login and get started	Joint Processing Form

If you have questions regarding the contents above please contact us or call the Allegiance Flex Enrollment Department at
1-877-424-3570 ext 4602.