Empower plans
Forms and resources
EmpowerSM consumer-driven plans from HealthPartners can help you save money and better manage your health care. The consumer-driven group includes FSA, HSA and HRA plans. Check out the forms and resources below to help better manage your plan.
- Automatic claims submission opt out request form
- Debit card merchant list
- Dependent care expense claim form
- Direct deposit form
- FSA eligible expense list
- FSA FAQs for employers
- FSA FAQs for members
- FSA partial eligible expense list
- Health care expense claim form
- Letter of Medical Necessity
- List of merchants covering 90% of eligible expenses
- Orthodontia reimbursement guidelines
- Spending account enrollment/election form
- Transportation and parking expense claim form