Group Insurance Savings save 25% to 50% (or more)
Payroll and Taxes Savings save 25% to 50% (or more)

application forms

Application and Enrollment to start your Assureflex Health Spending Account.
Application and Enrollment can be sent by email (PDF), or faxed, or mailed.

  • File

    Assureflex Application

     (177K)
    application form for employer, to be sent with employee enrollment forms
  • File

    Employee Enrollment

     (77K)
    enrollment form for employees, to be sent with employer application form