ENROLLMENT FORMS

Please select from the enrollment forms and templates below. You may download the fillable forms and templates to send securely via email to Service@Healthydollarsinc.com

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

Enrollment Form - HRA - Enrollment forms must be submitted to the service email above.
Enrollment Form - FSA- Enrollment forms must be submitted to the service email above.
Enrollment Form - DCA- Enrollment forms must be submitted to the service email above.
Enrollment Form - HSA - Enrollment forms must be submitted to the service email above.
Enrollment Form - COMMUTER- Enrollment forms must be submitted to the service email above.

Please complete one of the templates below for your enrollments if you have more than 20 employees to process.
Enrollment spreadsheet - FSA_DCA_LPFSA - Enrollment templates must be submitted to service email address above.
Enrollment spreadsheet - HRA - Enrollment templates must be submitted to service email address above.
Enrollment spreadsheet - FSA_DCA - Enrollment templates must be submitted to service email address above.
Enrollment spreadsheet - ICHRA-QSEHRA - Enrollment templates must be submitted to service email address above.