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Get the free HRA/FSA Direct Deposit Authorization Form

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What is HRA/FSA Direct Deposit

The HRA/FSA Direct Deposit Authorization Form is a crucial document used by employees to authorize BlueCross BlueShield of Tennessee for direct deposit of HRA/FSA reimbursements into their bank accounts.

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HRA/FSA Direct Deposit is needed by:
  • Employees of BlueCross BlueShield of Tennessee
  • Individuals enrolling in Health Reimbursement Accounts (HRAs)
  • Participants in Flexible Spending Accounts (FSAs)
  • Human Resources professionals managing employee reimbursements
  • Payroll departments ensuring accurate payment processing
  • Tax consultants assisting with reimbursement claims

How to fill out the HRA/FSA Direct Deposit

  1. 1.
    Access pdfFiller and log in or create an account if you don’t have one. Use the search feature to find the HRA/FSA Direct Deposit Authorization Form.
  2. 2.
    Once you have the form open, familiarize yourself with the fillable fields. Hover over each field for guidance on what information is required.
  3. 3.
    Gather the necessary information including your Subscriber ID, social security number, group name, and banking details. Have a voided check or deposit slip on hand for reference.
  4. 4.
    Start filling out the form by entering your personal information in the designated fields. Make sure to double-check for accuracy in your name, address, and social security number.
  5. 5.
    Fill in your bank account details including the account number and routing number. Ensure that these numbers are correct to avoid any issues with direct deposit.
  6. 6.
    Review all entries for accuracy. Ensure that your name matches the account holder’s name precisely and that all information corresponds to your bank records.
  7. 7.
    Once complete, save your work regularly by clicking the save icon at the top of the screen. This prevents data loss in case of an abrupt shutdown or network issue.
  8. 8.
    Download a copy of the completed form for your records. Click on the download button, select your preferred file format, and save it to your device.
  9. 9.
    Submit the form through pdfFiller if applicable. Alternatively, follow the provided instructions to print it out, attach your voided check or deposit slip, and send it to your HR department.
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FAQs

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Employees of BlueCross BlueShield of Tennessee who participate in Health Reimbursement Accounts (HRAs) or Flexible Spending Accounts (FSAs) are eligible to complete this form for reimbursement processing.
It is recommended to submit the form as soon as you enroll in an HRA or FSA to ensure prompt reimbursement. Check with your HR department for specific submission deadlines.
After completing the form, you can submit it via pdfFiller if this option is available. Otherwise, print the form, attach the required documents, and send it to your HR department via email or postal service.
You need to attach a voided check or deposit slip from your bank to the completed form. This is necessary to verify your bank account details for direct deposit.
Ensure that all entries are accurate, especially your routing number and account number. Also, make sure the name on the form matches the bank account holder's name to prevent processing issues.
Processing times can vary, but typically, once submitted, the direct deposit setup can take a few business days. Be sure to check with your HR department for specific timelines.
If you need to update your banking information, you must fill out a new HRA/FSA Direct Deposit Authorization Form and submit it following the same procedures as the initial submission.
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