Benefits Design Group - Onalaska, WI
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Medical Mileage Rates Released for 2013 Read the story.
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Free Money in Flexible Spending Accounts! Read the story.

Forms & Information

Use the following forms to enroll in a plan, report a change in status, or request reimbursement of a qualified expense. The forms are in Adobe Acrobat format. If you don't have Acrobat Reader, you can download a free copy here. After downloading the appropriate form, you can print the form and mail them to:

Benefits Design Group, Inc.
PO Box 370
Onalaska, WI 54650

or fax them to (608) 781-4576.

 MC900440035_1_

See Forms Updated for 2013 Renewal Season Below:

Flexible Spending Accounts (FSA)

The forms below should be used by Flexible Spending Account participants only.  If you have another type of program, please scroll down farther in the listing to make sure you use the correct form. 

Warning:  Use of incorrect claim forms, may DELAY your reimbursements.  Please contact our office at 1-800-342-8235 if you are unsure about which ones to use for your plan.

 

Employer Forms-Flexible Spending Accounts (FSA)

 

Health Reimbursement Arrangements (HRA)

The forms below should be used by Health Reimbursement Arrangement (HRA) participants only.  If you have another type of program, please scroll up or down in the listing to make sure you use the correct form. 

Warning:  Use of incorrect claim forms, may DELAY your reimbursements.  Please contact our office at 1-800-342-8235 if you are unsure about which ones to use for your plan.

 

Employer Forms-Health Reimbursement Arrangement

 

Participants with both HRA and FSA Plans

The forms below should be used by participants who have both HRA and FSA plans only.  These participants are required to submit to the HRA program first and then any eligible claims can be resubmitted to the FSA plans authomatically.  If you have another type of program, please scroll up or down in the listing to make sure you use the correct form. 

Warning:  Use of incorrect claim forms, may DELAY your reimbursements.  Please contact our office at 1-800-342-8235 if you are unsure about which ones to use for your plan.

 

Participants with both FSA and HRA Plans

The forms below should be used by participants who have both FSA and HRA plans only.  These participants are required to submit to the FSA program first and exhaust all FSA funds before claims are eligible to be processed in the HRA.  If you have another type of program, please scroll up or down in the listing to make sure you use the correct form. 

Warning:  Use of incorrect claim forms, may DELAY your reimbursements.  Please contact our office at 1-800-342-8235 if you are unsure about which ones to use for your plan.

Transportation Plan Forms 

 

Other Miscellaneous Forms

Benefits Design Group - Employee Info Benefits Design Group - Employer Info Benefits Design Group - My Benny
Benefits Design Group, Inc. | 701 Sand Lake Rd, PO Box 370, Onalaska, WI 54650 | Toll Free: (800) 342-8235, (800) 554-7213 | Email: bdggeneral@bdgflex.com
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