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Contact Info Eide Bailly Employee Benefits 5601 Green Valley Drive Suite 710 Minneapolis, MN 55437-1145 P: 952.944-6633 / 800.300.1672 F: 952.918.3622 / 877.918.3622 E-mail: benefits@eidebailly.com

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State of Minnesota Forms and Plan Information

Forms
Select a Form... -------------------- 2010 Forms ------------------------ Direct Deposit Lost Check Affidavit Form MDEA/DCEA/HRA Reimbursement Form Pre-Tax Benefits Enrollment Form Pre-Tax Benefits Change in Participation Form Transit Benefits Change in Participation Form Transit Benefits Enrollment Form Transit Benefits Reimbursement Form

Plan Information
Make a Selection... -------------------- 2010 Plan Info ------------------------ Enrollment Information Pre-Tax Benefits 2010 Plan Year Summary Health Reimbursement Account (HRA) Summary Plan Description Dependent Care Expense Account (DCEA) Worksheet Health Reimbursement Arrangement (HRA) Expense Worksheet Medical/Dental Expense Account (MDEA) Worksheet Over-the-Counter Eligible Expense List Health Reimbursement Arrangement (HRA) Frequently Asked Questions Health Reimbursement Arrangement (HRA) Information MDEA Documentation Examples Transit Expense Account Documentation Example

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MNSCU Forms and Plan Information

MNSCU Forms
Select a Form... 2010 Reimbursement Form

Plan Information
Make a Selection... -------------------- 2010 Plan Info ------------------------ Health Reimbursement Account (HRA) Accounts Q&A Health Reimbursement Account (HRA) Amendment Health Reimbursement Account (HRA) Expense Worksheet Health Reimbursement Account (HRA) Information HRA vs HSCP Contribution Flowchart HRA potential Forfeiture Flowchart