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The Benny Prepaid Benefits Card
Dental Network Card Program
Health Economics Group - Your Benefits Partner Since 1978
  Forms

Here are many important forms related to your enrollment, benefits, and claims. We hope that their online availability will make your communication with HEG even easier.

• Dental Claim Form

• Flexible Spending Account Claim Form

• Flexible Spending Account Claim Form - Limited-Use

• Flexible Benefits Program Change Form

• Health Reimbursement Account Claim Form

• Direct Deposit Authorization

• W-9 Form - Request for Taxpayer Identification # and Certification

• W-10 Form - Dependent Care Provider's Identification and Certification

• MVP Health Care - Preferred Gold HMO & GoldAnywhere PPO Dental Claim Form

 

 
HEG Dental Network Card Program
The Benny Prepaid Benefits Card

 

1050 University Avenue, Suite A • Rochester, NY 14607 • 585-241-9500 or 1-800-666-6690