Peter Zappa & Associates : Employer Forms

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Information for Employers: Forms

This part of our web site displays some of the most frequently used forms by our clients. Each form has been designed and redesigned over the years to meet our clients’ administrative requirements.

FLEXIBLE SPENDING ACCOUNTS

CHANGE REQUEST FORM
Request for a plan change for an individual plan participant.

LIFE STATUS CHANGE FORM
Please be sure to review the QUALIFYING EVENTS prior to submitting the Life Status Change Form.

QUALIFIED EVENT NOTICE FORM
COBRA information required by Zappa & Associates for completion of Qualified Beneficiary letter.

2005 FLEXIBLE SPENDING ACCOUNT ENROLLMENT FORM
Completed by employee for participation in Medical or Dependent Day Care Flexible Spending Account.

DENIAL FORM
Sent to plan participant whenever a claim or portion of a claim is denied.

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