- 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.
Looking for details on the COBRA Subsidy? Check out the Subsidy Resource page.
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.