Health Plan documents

2024 Summary of Benefits – Standard Plans

Highlights of the covered benefits and general plan design for the 2024 standard plans (Fenyx Health Group MSA 50, 100 and 200)

Provider Guide

A summary of the Fenyx Health Group MSA plans for providers

2024 Evidence of Coverage – Group MSA 50, 100 and 200 Plans

Detailed information about the Fenyx Health Group MSA 50, 100 and 200 plans for the 2024 benefit year

Appointment of Representative Form

Use this form to designate a person authorized to represent you for health plan and healthcare matters

MSA Banking documents

2024 MSA Custodial Account Agreement

The agreement for the IRS-deemed custodial bank account for the Fenyx Health Group MSA plans

ACH Transfer Request Form

Use this form to reimburse yourself for your Qualified Medical Expenses with funds from your MSA bank account

MSA Bank Account Beneficiary Designation Form

Use this form to designate the beneficiary of your MSA bank account assets upon your passing