Access Account

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Forms

To download a form, select the form name below.

Claim Forms

To request reimbursement for eligible expenses, complete the claim form for your plan below. Follow the instructions outlined on the form.

PDF DocumentFSA Claim Form

PDF DocumentHRA Claim Form

Direct Deposit Form

If you would like claims reimbursements to be directly deposited into your checking or savings account, complete the Direct Deposit Authorization Form below. Instructions on how to submit your authorization are included on the form.

PDF DocumentAuthorization for Direct Deposit Form

Medical Determination Form

Some expenses must be medically necessary in order to be eligible for reimbursement. Along with your claim, you must submit a Medical Determination Form completed by your health care provider. To learn if your expense requires this form, see eligible expenses.

PDF DocumentMedical Determination Form

BB&T Benefit Access Card Replacement

To request replacement of your access card, or order an additional card, complete the form below. Follow the instructions outlined on the form.

PDF DocumentReplacement Card Form

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