- COBRA Refund Request Form
- Please use this form to authorize an ACH refund to your account.
- PHI Authorization/Revocation Form
- COBRA Brochure
- Answers the many questions you may have regarding your COBRA benefits.
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.
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.
