Employer Forms

ELECTRONIC FORMS: Simply click on the navigation link listed for the form you’re needing. When the form comes up on your computer, simply fill in the requested fields. Once complete, click the “Send” button at the bottom of the form.


PDF "Fillable" Forms

NOTE: Please download the PDF forms to your computer before filling them out. Please be sure to follow instructions listed on the form. Please “Type ” your information into the form, making sure to complete each section in its entirety. Print, sign, date and fax or U.S. Mail to IntegraFlex. By doing so, you will ensure your submission is processed correctly and in a timely manner.

PDF "Fillable" Employer Plan Set-Up Applications:

COBRA Administration

COBRA Benefit Plan Changes

Carrier Change of COBRA TPA Notification

Employer Intake for FSA/HRA/HSA

Premium Only Plan (POP) Set-Up

Administrative Fees - ACH Bank Authorization

Claims - Bank Authorization

PDF Employer Brochures:

Employer COBRA Brochure