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Insurance Solutions
Claims

Insurance Forms

Flexible Spending Account Forms
        Flexible Spending Account - Enrollment Form
        Flexible Spending Account - Benny Prepaid^TM Visa^® Card brochure
        Flexible Spending Account - Claim Form
        Flexible Spending Account - Eligible Medical Expenses
        Flexible Spending Account - Ineligible Medical Expenses
Miscellaneous Forms
Healthcare Reimbursement Arrangement Claim Form
Certification of Medical Necessity - Submission Form

Customer Service Center: (866) 440-0391

Investment, Tax, Payroll and Insurance products and services offered through Ulster Insurance Services, Inc.
and Ulster Financial Group, Inc., subsidiaries of Ulster Savings Bank, are NOT FDIC INSURED.