Employers, please select from the enrollment forms and templates below. You may download and complete the fillable forms and templates to send securely via email to service@healthydollarsinc.com.

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Please select the appropriate forms from below for your enrollments if you have fewer than 20 employees to process.

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• Enrollment Form - HRA - Health Reimbursement Account
   

• Enrollment Form - FSA - Flexible Spending Account
   

• Enrollment Form - DCA - Dependent Care Account
   

• Enrollment Form - HSA - Health Savings Account
   

• Enrollment Form - COMMUTER - Commuter and Transit Account

 

Please complete one of the templates below for your enrollments if you have more than 20 employees to process.

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• Enrollment spreadsheet – FSA_DCA_LPFSA – Flexible Spending, Dependent Care and Limited Flexible Spending Accounts
   

• Enrollment spreadsheet - HRA – Healthcare Reimbursement Accounts
   

• Enrollment spreadsheet – FSA_DCA – Flexible Spending and Dependent Care Accounts
   

• Enrollment spreadsheet – ICHRA_QSEHRA - ICHRA-QSEHRA Accounts