For your convenience, we have provided commonly used forms in an online format. Forms can be sent to us by fax at (800) 421-6737. Forms can also be submitted by mail. Please send the form to:

Secure Benefits Systems Corporation
Box 469
Okoboji, IA 51355

Forms Available:

Claim for Reimbursement

Mid-Year Election Change Form

Flexible Benefit Compensation Reduction Agreement

Flexible Benefits Plan Medical Expense Reimbursement Account Continuation Election Form

Employer Information Data Sheet For Section 125 Plan Set-up

Authorization Agreement for Automatic Deposits (ACH Credits)

Over the Counter List (note: these items will no longer be eligible 1/1/2011)

To view these forms, you will need Adobe Acrobat Reader.