Please print or save the desired form to your desktop, enter all the required data, sign and mail or fax it to Security Benefit (Fax: 785.438.4944). For additional assistance in filling out the forms, please view the instructions.
Please print or save the desired form to your desktop, enter all the required data, sign and mail or fax it to Security Benefit (Fax: 785.438.4944). For additional assistance in filling out the forms, please view the instructions.
Employee Forms
Use this form to establish a new VEBA Account. Provide your employer a copy of this form.
Use this form to modify or change information on your account.
Use this form to request medical expense and premium reimbursement.
If you have a recurring reimbursement existing and want to change method of receipt from check to EFT, complete this form.
Employer Forms
Plan Sponsor will use this form to notify Security Benefit when a participant has a change in employment status and to indicate vesting.