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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 Benefits Program Change Form

• Funds Transfer Agreement

• Direct Deposit Authorization

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

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

 

 

1050 University Avenue, Suite A • Rochester, NY 14607 • 585-241-9500