PHSP/HSA Plan Forms

These PDF forms can be downloaded and printed, or filled in and emailed (see the top left-hand corner of each PDF).
Try our secure email service to send us any document.  Follow this link
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1. Registration Form

We need this for all plans.  As with any of these forms, call us if you need help.

2. Appendix A – Eligible Employee(s)

Appendix A is required for all incorporated businesses AND proprietorships with arms-length employees.

3. Appendix B – Plan Configuration & Funding Options

We need Appendix B for all plans. Please call for assistance if you need it.

4. Appendix C – Family Members

Appendix C is required for unincorporated businesses only.

5. Pay-As-You-Go Plan Claim Form

Just give this claim form to your employer, signed and with receipts, in order to process your claim.

6. Pre-Authorized Plan Claim Form

You can send this claim and receipts directly to us, bypassing your employer if you are on a PAD plan.

7. Direct Deposit Request Form

By sending us a VOID cheque you agree to the terms of this request form whether you send this form or not.

8. Pre-Authorized Debit Agreement

This form only needs to be signed and submitted once, and can be cancelled at any time.

A Note About Our One-Time Plan Registration Fee:  To make credit card payments online to DR Associates, go to "2. Fund Your Plan".  A 3% surcharge will apply to all credit card payments EXCEPT the one-time $100.00 registration fee.  No GST is payable on the registration fee.

Register Online Now