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Admin America, Inc.

Alpharetta, GA 30005

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Open Enrollment Forms Wizard

Home Open Enrollment Forms Wizard

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  • In response to COVID-19, the IRS has amended several regulations. For details see the Webinar posted on the Admin America Blog. If you need to submit a Flexible Benefits Plan Amendment Request Form based on these IRS amendments, click HERE.


    Complete this questionnaire to receive open enrollment materials based on the benefit(s) you hold with Admin America, Inc.

  • There may be a slight delay when selecting the below options.

    Check all that apply:
  • What is an EDI Vendor?
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  • Census templates take priority over enrollment forms
  • Debit Cards are offered by Admin America at no additional administrative cost
  • I want to learn more about grace extension
  • Please Note: IRS regulations do not allow both rollover and grace extension at the same time for the Medical FSA or Limited Purpose FSA plans.
  • I want to learn more about rollover
  • What are the maximum IRS election amounts?
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    Available with all HSA plans. Optional with all other plans.


  • Download the Direct Deposit Set-Up Guide by clicking on the link below:

    Direct Deposit Setup Guide

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  • Download the Employer Portal Guide by clicking on the link below:

    Employer Portal Training Guide

  • FSA, HRA, & HSA Employer Portal Training occurs several times. Please register for the date and time that works best for you: Signup Here During this training session we will review the Employer Portal for FSA, HRA, & HSA lines of service. After registering, you will receive a confirmation email containing information about joining the webinar. Brought to you by GoToWebinar® Webinars Made Easy®
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  • Based on the answers provided, the materials below have been customized to your plan. Click the links below to download your materials.

    EMPLOYER & BROKER FORMS
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • FSA Census Spreadsheet Template
  • HRA Census Spreadsheet Template
  • HSA Census Spreadsheet Template
  • HRA Plan Amendment Abstract
  • Employer Portal Training Guide
  • Non-Discrimination Test Letter

  • EMPLOYEE FORMS
  • HRA Enrollment Form
  • HSA Enrollment Form
  • Transit / Parking FSA Enrollment Form
  • Transit/Parking FSA Enrollment Form (Fill this form with your maximum election)
  • Dependent Care FSA Enrollment Form
  • Dependent Care FSA Enrollment Form (Fill this form with your maximum election)
  • Dependent Care FSA Enrollment Form
  • Dependent Care FSA Enrollment Form (Fill this form with your maximum election)
  • Limited Purpose FSA Enrollment Form
  • Limited Purpose FSA Enrollment Form (Fill this form with your maximum election)
  • Limited Purpose FSA Enrollment Form
  • Limited Purpose FSA Enrollment Form (Fill this form with your maximum election)
  • Medical FSA Enrollment Form
  • Medical FSA Enrollment Form (Fill this form with your maximum election)
  • Medical FSA Enrollment Form
  • Medical FSA Enrollment Form (Fill this form with your maximum election)
  • Dependent Care & Limited Purpose FSA Enrollment Form
  • Dependent Care & Limited Purpose FSA Enrollment Form (Fill this form with your maximum election)
  • Dependent Care & Limited Purpose FSA Enrollment Form
  • Dependent Care & Limited Purpose FSA Enrollment Form (Fill this form with your maximum election)
  • Medical & Dependent Care FSA Enrollment Form
  • Medical & Dependent Care FSA Enrollment Form (Fill this form with your maximum election)
  • Medical & Dependent Care FSA Enrollment Form
  • Medical & Dependent Care FSA Enrollment Form (Fill this form with your maximum election)
  • Medical & Limited Purpose FSA Enrollment Form
  • Medical & Limited Purpose FSA Enrollment Form (Fill this form with your maximum election)
  • Medical & Limited Purpose FSA Enrollment Form
  • Medical & Limited Purpose FSA Enrollment Form (Fill this form with your maximum election)
  • Medical, Limited Purpose & Dependent Care FSA Enrollment Form
  • Medical, Limited Purpose & Dependent Care FSA Enrollment Form (Fill this form with your maximum election)
  • Medical, Limited Purpose & Dependent Care FSA Enrollment Form
  • Medical, Limited Purpose & Dependent Care FSA Enrollment Form (Fill this form with your maximum election)
  • Commuter Benefits Fact Sheet
  • 2021 Dependent Care Fact Sheet
  • Medical FSA Fact Sheet
  • Medical FSA Fact Sheet
  • Medical FSA Fact Sheet
  • Medical FSA Fact Sheet
  • Limited Purpose FSA Fact Sheet
  • Limited Purpose FSA Fact Sheet
  • Limited Purpose FSA Fact Sheet
  • Limited Purpose FSA Fact Sheet
  • Medical & Limited Purpose FSA Fact Sheet
  • Medical & Limited Purpose FSA Fact Sheet
  • Medical & Limited Purpose FSA Fact Sheet
  • Medical & Limited Purpose FSA Fact Sheet
  • Medical & Dependent Care FSA Fact Sheet
  • Medical & Dependent Care FSA Fact Sheet
  • Medical & Dependent Care FSA Fact Sheet
  • Medical & Dependent Care FSA Fact Sheet
  • Limited Purpose & Dependent Care FSA Fact Sheet
  • Limited Purpose & Dependent Care FSA Fact Sheet
  • Limited Purpose & Dependent Care FSA Fact Sheet
  • Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical FSA Fact Sheet
  • Medical FSA Fact Sheet
  • Limited Purpose FSA Fact Sheet
  • Limited Purpose FSA Fact Sheet
  • Medical & Limited Purpose FSA Fact Sheet
  • Medical & Limited Purpose FSA Fact Sheet
  • Medical & Dependent Care FSA Fact Sheet
  • Medical & Dependent Care FSA Fact Sheet
  • Limited Purpose & Dependent Care FSA Fact Sheet
  • Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical FSA Fact Sheet
  • Medical FSA Fact Sheet
  • Limited Purpose FSA Fact Sheet
  • Limited Purpose FSA Fact Sheet
  • Medical & Limited Purpose FSA Fact Sheet
  • Medical & Limited Purpose FSA Fact Sheet
  • Medical & Dependent Care FSA Fact Sheet
  • Medical & Dependent Care FSA Fact Sheet
  • Limited Purpose & Dependent Care FSA Fact Sheet
  • Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet
  • Medical FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Medical FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Medical & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Medical & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover)
  • Medical FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Medical FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Medical & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Medical & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Medical, Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period)
  • Medical FSA Fact Sheet (Fill this form with your maximum election)
  • Medical FSA Fact Sheet (Fill this form with your maximum election)
  • Limited Purpose FSA Fact Sheet (Fill this form with your maximum election)
  • Limited Purpose FSA Fact Sheet (Fill this form with your maximum election)
  • Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election)
  • Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election)
  • Medical & Dependent FSA Fact Sheet (Fill this form with your maximum election)
  • Medical & Dependent FSA Fact Sheet (Fill this form with your maximum election)
  • Limited Purpose & Dependent FSA Fact Sheet (Fill this form with your maximum election)
  • Limited Purpose & Dependent FSA Fact Sheet (Fill this form with your maximum election)
  • Medical, Limited Purpose & Dependent FSA Fact Sheet (Fill this form with your maximum election)
  • Medical, Limited Purpose & Dependent FSA Fact Sheet (Fill this form with your maximum election)
  • PHI Use or Disclosure Form
  • HRA Reimbursement Documentation Form
  • FSA Reimbursement Documentation Form
  • Direct Deposit Setup Guide
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • Electronic Claim Filing or Submission
  • FSA Reimbursement for Non-Debit Card Expenses
  • Consumer Portal Login Guide for PC and Mobile App
  • Your Prepaid Benefits Card
  • TPA Stream FAQ
  • HRA and HSA Dual Account Management
  • If you would like to have access to this page again, click 'Save and Continue Later' for a link to your forms. This link will expire after 30 days. We recommend that you download all forms within this 30 day period.
  • This field is for validation purposes and should be left unchanged.
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We provide expert welfare benefit plan advice to both brokers and businesses. With 30 years of experience we’ll ensure that you’re always getting the best guidance from the most professional company offering both administration and compliance.

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  • ERISA Wrap

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