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WEX Health Card
Dental Network Card Program
Health Economics Group - Your Benefits Partner Since 1978
  Forms

Here are many important forms related to your enrollment, benefits, and claims. We hope that their online availability will make your communication with HEG even easier.

Dental Claim Form

Flexible Spending Account Claim Form

Flexible Spending Account Claim Form - Limited-Use

Census Data Change Form

Health Reimbursement Account Claim Form

Direct Deposit Authorization

W-9 Form - Request for Taxpayer Identification # and Certification

W-10 Form - Dependent Care Provider's Identification and Certification

MVP Medicare Dental Claim Form

Debit Card - Substantiation Form

Monroe County Parking Claim Form

 

 

HEG Dental Network Card Program
WEX Health Card

 

1050 University Avenue, Suite A • Rochester, NY 14607 • 585-241-9500 or 1-800-666-6690