Vantage Flex, LLC HOME FORMS FSA/HRA STORE HIPAA/PII SECURITY SERVICES CONTACT US MY ACCOUNT Quick Forms Request for Reimbursement This form is used to request reimbursement from your account and must be accompanied by proof of the expense that you are requesting the reimbursement for. Employer Forms POP Plan Adoption Agreement Adoption Agreement Checklist This checklist is used when setting up any type of reimbursement plan. Service Agreement This form explains the terms of our agreement. Information Checklist This is the checklist of items we need to install any of the plans. Change of Status Matrix HRA / FSA Election or Change Form This form should be used for employees to make Elections and Election changes to their HRA and/or FSA plan. Section 125 Demo Referral Form Refer another business to receive a discount on your fees Employee Forms Eligible Expenses This form shows IRS Eligible Section 213(d) Expense descriptions and documentation required for Standard FSA Plans, Limited Purpose FSA Plans, and HRA Plans. NOTE: not all expenses may be eligible for your plan; please refer to your Employers Summary Plan Description for a list of eligible benefits your plan covers. OTC LIST This is a news release regarding Over The Counter Drugs. Also check out www.FSAstore.com of which we have a link on this site. Dependent Care Claim Form This form is used to submit a Request for Reimbursement from your Dependent Care Account. Dependent Care Receipt This form is used by an employee to show they incurred an eligible expense for Dependent Care. Employee Election Form This form is used by the employees prior to the begining of each new plan year to elect the benefits the are participating in. Change of Status Form This form will allow an employee to make a change to their election if they have a qualifying event. FSA COBRA Form Site Mailing List The Future of Employee Benefit Administration Vantage Flex, LLC 413 10th Avenue Menominee, MI 49858 Phone: (906) 863-3539 Email: bill@vantageflex.com

Vantage Flex, LLC HOME FORMS FSA/HRA STORE HIPAA/PII SECURITY SERVICES CONTACT US MY ACCOUNT Employer Login ATTENTION! If you are currently or still experiencing login issues, please email bill@vantageflex.com or matt@vantageflex.com and we will attempt to figure out the issue. Employee Login Site Mailing List The Future of Employee Benefit Administration Vantage Flex, LLC 413 10th Avenue Menominee, MI 49858 Phone: (906) 863-3539 Email: bill@vantageflex.com