Get A Proposal

Forms & Documents

Filter by Category
This text appears above the facets! {content} This text goes below the facets.

HRA/SRA Travel Attestation Form

View Document

COBRA Refund Request Form

View Document

Claim Form

View Document

PHI Authorization/Revocation Form

View Document

COBRA Brochure

View Document

Withdrawal Request Form (UMB)

View Document

Name Change Form (UMB)

View Document

Transfer Form (UMB)

View Document

Beneficiary Form (UMB)

View Document

Medical FSA Expense Worksheet

View Document

Enrollment/Change Form CBP

View Document

Opt Out Form FSA

View Document

Simplifying the complexity of benefits for maximum savings and peace of mind.

Facebook-f Twitter Linkedin-in

Contact Information

245 Kenneth Drive
Rochester NY 14623-4277

Benefit Resource, LLC
PO BOX 642
Willow Grove, PA 19090

EMPLOYEES: (800) 473-9595
EMPLOYERS: (866) 996-5200

For Employees

For Employers

CoMpany

The Beniversal and eTRAC Prepaid Mastercards are issued by The Bancorp Bank pursuant to license by Mastercard International Incorporated. Mastercard is a registered trademark, and the circles design is a trademark of, Mastercard International Incorporated. The Beniversal and eTRAC cards are accepted at qualified merchants accepting Debit Mastercard. The Bancorp Bank; Member FDIC.

HSA Custodial Services are provided by a separate financial institution. See your HSA Account Agreement for specific account terms.