Box Top Benefit Help Solutions Logo Woman holding boy We make it easy.
Members

Customer Service
503-219-3679
888-398-8057

E-mail home

Forms

Note: Forms are in PDF format. You will need Adobe® Acrobat Reader to read PDF files.

Claim Forms

Enrollment and Change Requests

These forms are fillable forms. If you need a copy that you can print and complete by hand, please contact your employer.

Additional Forms

To file an appeal please visit, benefithelpsolutions.com/members/fsa_file_appeal.shtml.

Send forms to:
Flexible Spending Accounts Administration
P.O. Box 67230
Portland, OR 97268-1230
888-249-5058 Fax toll-free

Box Bottom