GENERAL FORMS

Download Our Forms to Enroll or Change Services. Employee Enrollment can be completed by either Individual Employee Forms or by List Enrollment

HRA

Employer HRA Application

Employer Rx Application

Employee Enrollment/Change Form

Employee Waiver Form

HRA Claim Form

FSA

Employer FSA Application

POP Application

Employer FSA Anti-Discrimination Form

Employee FSA Enrollment Form

Employee FSA Change Form

FSA Claim Form- Health

FSA Claim Form- DCAP

COBRA

COBRA Application

COMPLIANCE

Compliance Application

EMPLOYEE LIST ENROLLMENT

Employee Census List

WHAT OUR CLIENTS SAY

Group Health Consultant from Wilmington, NC
“…RP Riley's plans are easy to sell when you are talking to the right person in the group such as the CFO or President or CEO of the company…”
Client from Fremont, TX
“… Our firm has had a Medical Reimbursement Expense Plan for 6 years. We have saved money each year, and continue to do so. We would never go back to a regular insurance plan…”
Client from San Diego, CA
“…In the first 6 months we had paid expenses and claims that equaled $671,900, under the plan. Last year at the same time we spent over $1.4 million. RP Riley's HRA is working very well…”
Group Broker from Elk Grove Village, IL
“…I have never had a group that did not save money using a HRA plan designed by RP Riley. Administration expenses and employee claims subtracted from premium savings – this still produced great savings…”  
Client from Oakland, CA
“…Yes, reimbursement plans are adding a new layer of complexity, but sometimes, they can provide a breath of fresh air too. I believe your people will find RP Riley to be very customer friendly and more than willing to resolve questions your people might have.  Compared to some big insurance companies, the RP Riley people are very helpful and friendly, from what I have seen and heard. I only ask that everyone give it a chance to work…”