These forms can be completed and processed online as long as you are registered and have logged on to the site.

• If you are not registered, click on “Not Registered” at the top of the page and follow the registration instructions.
• If you are registered, but not currently logged in, you will be redirected to the login page.
• Once you are logged in, the form will prefill with your personal information on file (i.e. name, Health Plan ID, etc.)
• Complete the form online, attach any required document(s) and submit for processing.

Click on the PDF or MS Word symbol to display the form.

• Download the form.
• You can then print and fax or mail it to the ASEA Health Trust Administrator for processing.

Form	Description	Process Online	Display
HCRA Reimbursement Form	Use this form to submit itemized bills or receipts for reimbursement under your Health Care Reimbursement Account Plan.
Health Reimbursement Arrangement Plan	Use this form to submit information for eligible expenses incurred by you, your spouse, or other eligible dependents, for which you are requesting reimbursement under the HRA Plan. Remember to also submit the required supporting documentation.
Direct Deposit Form	Use this form to request that your HCRA and/or HRA reimbursements be deposited directly to your bank account.