Service Forms

Other

Asset Reallocation for Group Healthcare Reimbursement Account

Use this form to automatically transfer account values to maintain a specific percentage allocation among your current and future investment options.

Download
By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942
Other

Asset Reallocation for Healthcare Reimbursement Account

Use this form to automatically transfer account values to maintain a specific percentage allocation among your current and future investment options.

Download
By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942
Other

Change Investment Allocation for Healthcare Reimbursement Account

Use this form to modify your existing and/or future investment allocations.

Download
By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942
Other

Change Investment Allocations for Group Healthcare Reimbursement Account

Use this form to modify your existing and/or future investment allocations.

Download
By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942
Other

Claim Form for Group Healthcare Reimbursement Account

Use this form to request medical expense reimbursement following severance from employment.

Download
By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942
Other

Dollar Cost Averaging for Healthcare Reimbursement Account

Use this form to request periodic exchanges from one investment option to one or more investment options.

Download
Download
Other

Employee Change Notification for Healthcare Reimbursement Account

Use this form to change employee status. Complete this form and enclose it with your payroll for any new employees not listed or terminated since the last contribution list.

Download
By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942
Other

Employee Enrollment for Healthcare Reimbursement Account

Use this form to establish a new Healthcare Reimbursement Account. Provide your employer a copy of this form.

Download
By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942
Other

Employer Information for Healthcare Reimbursement Account

Use this form for each employee group adopting the Security Benefit Group Healthcare Reimbursement Account (HRA).

Download
By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942
Mutual Fund | Variable Annuity | Other

Non-Financial Change for Custodial Account

For changing the name and/or address of the existing Annuitant/Participant, Beneficiary(ies), Owner, or Joint Owner of the Contract.

Download

Please type or print in black ink. Complete all necessary fields and signatures.

By Mail

Security Benefit
Retirement Plan Services
PO Box 219141
Kansas City, MO 64121-9141
United States

Overnight Delivery

Security Benefit
Retirement Plan Services
430 W 7th Street STE 219141
Kansas City, MO 64105-1407
United States

By Fax
Download
For questions or assistance, please call 800.747.3942