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Security Benefit Healthcare Reimbursement Account (HRA) Forms

For help on filling out the forms, please view the form completion instructions.

Form Description
Asset Reallocation Use this form to automatically transfer account values to maintain a specific percentage allocation among your current and future investment options.
Change Investment Allocations Use this form to modify your existing and/or future investment allocations.
Claim Form Use this form to request medical expense reimbursement following severance from employment.
Dollar Cost Averaging Use this form to request periodic exchanges from one investment option to one or more investment options.
Custodial Account Non-Financial Change
(Name, Address, etc.)
Use this form to modify or change information regarding the roles on your account.

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Services are offered through and securities distributed by Security Distributors, a subsidiary of Security Benefit Corporation (Security Benefit).

Security Benefit is a leading provider of retirement plan services throughout the nation, primarily in the education marketplace. Security Benefit offers trust account programs under 401(k) and 401(a) and under §401 of the Internal Revenue Code; voluntary custodial accounts under 403(b)(7) ERISA and 403(b)(7) of the Internal Revenue Code; §457 Governmental Programs; and trust account Top Hat programs under §457(g) of the Internal Revenue Code; and Voluntary Employees' Beneficiary Association (VEBA) trust programs qualified under Section 501(c)(9) of the Internal Revenue Code.

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