Benefit Services of Hawaii. – sol(u)tions

Forms

(free download for viewing PDF files Adobe Reader)

• Flexible Spending Plan Reimbursement Form
• Pretax Transportation Benefit
• Reimbursement Form
• Change/Cancellation Form

TDI Forms

• TDI Claim Form and Instructions
• TDI - Return to Work Notice
• USAble Life

Health Insurance Portability and Accountability Act (HIPAA) Forms

• Authorization to Appoint a Personal Representative Form
• Request to Revoke Authorization Form