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 Group Healthcare Reimbursement Account

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

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

Letter of Medical Necessity for Security Flex 125 Program®

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

Medical/Dependent Care Reimbursement Program Claim for Security Flex 125 Program®

Download

Use this form to request medical expense or dependent care reimbursement. 

By Mail

Security Flex 125
P.O. Box 75066
Topeka, KS 66675
United States

Overnight Delivery

Security Benefit
Mail Zone 600
One Security Benefit Place
Topeka, KS 66636
United States

By Fax
Download
You may also email your form to [email protected]
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