Section 125 (Cafeteria Plan Administration)

TASC - FlexSystem (Total Administrative Services Corporation) – Click Here

EMPLOYEES - Access Your Account Online
EMPLOYERS - Access Your Account Online
TASC Direct Deposit Form

HCap (formerly FlexBen)
HCap Strategies Claim Form.pdf

Cafeteria Plan Guide

Insurance Carrier Forms/Links

Allstate - Click Here
Allstate Change of Beneficiary Form
Allstate Bank Draft Authorization Form
Allstate Policyholder's Change & Service Request Form
Allstate All in One Claim Form

Ameritas Dental and Vision - Click Here
Dental Claim Form
Vision Claim Form

Assurant Employee Benefits (Formerly Assurant Fortis Benefits)
Assurant Benefits Online Advantage
Assurant Life Beneficiary Desgnation Form
Assurant Life Beneficiary Change Form
Assurant Life & Dental Faxable Change Form
Assurant Dental COBRA Election Form
Assurant Dental Claim Form
Assurant Life Claim Form for Employer
Assurant Life Claim Form for Beneficiary
Assurant Disability Claim Form
Assurant Disability Claim Form Instructions
Assurant Disability Policy Service Request Form


Bay Bridge Administrators, LLC
Hartford/AIG/Nat'l Fire Insurance Co.
Cancer and Wellness Check Claim Form
Hartford Cancer Tips
Hartford Policy Change Form
Hartford Claim Form For Cancer, Specified Disease, and Intensive Care Coverage
AIG/National Union Fire Insurance Cancer and Wellness Claim Form

Central United Life - Click Here
Central United - Cancer & Specified Disease Claim Form
Bank Draft Authorization Form
Vision Claim Form
Central United Cancer Wellness Screen Claim Form
Central United Policy Change Form

Comp Benefits – Click Here
Comp Benefits Claim Form

Conseco/Jefferson National - Click Here
Conseco Cancer Claim Form
Conseco / Jefferson National Policy Change Form

Dental Select - Click Here
Dental Select Claim Form
Dental Select Change Request Form
Dental Select Multiple Member Cancellation Form
Dental Select Help Hints

Fort Dearborn Life - Click Here
FDL Enrollment & Change Form
FDL Death Claim Form
FDL Policyholder Change Form

Guardian - Click Here
Guardian COBRA Election Form
Guardian Dental Claim Form

InRoll / Online Enrollment System - Click Here
Employee Add / Term / Change Form

Life Re - Click Here
LifeRe Dental Claim Form
LifeRe Change of Status Form

Paid Dental - Click Here

Pre Paid Legal - Click Here

QCD Discount Dental Plan- Click Here

Reliance Standard AD&D Click Here
RSLIC Change of Beneficiary Form

Safeguard Dental Plans - Click Here
Safeguard Dental Claim Form
Safeguard Dental Change Form

Spectera (Sight Select) - Click Here
Spectera Vision Claim Filing Instructions
Sight Select Application and Change Form


Texas Life - Click Here
Texas Life Change of Beneficiary Form
Texas Life Transfer of Ownership Form
Texas Life Change or Correction of Name Form
Texas Life Bank Draft Form

Transamerica
Cancer, Specified Disease, Intensive Care, Hospital & Heart, Accident
Transamerica Policy Change Request Form
Bank Draft Authorization
Transamerica Multi Purpose Claim Form

Vision Service Plans (VSP) - Click Here

Investment Advisory Services offered through Legend Advisory Corporation,
a registered investment advisor. Securities offered through
Legend Equities Corporation, Member FINRA and SIPC.