Quantcast
Connect With Us Connect with LinkedIn Eide Bailly Blogs Watch Us on YouTube Connect with Facebook Follow Us on Twitter

Contact Us

Eide Bailly Employee Benefits
U.S. Bancorp Center
800 Nicollet Mall, Suite 1350
Minneapolis, MN 55402-7033

FSA, HRA, HSA Help
P: 612.253.6633
800.300.1672
F: 612.253.6622
877.918.3622
Or e-mail with general inquiries:
benefits@eidebailly.com

COBRA Help
P: 612.253.6633
800.300.1672
F: 612.253.6622
877.918.3622
Or e-mail with general inquiries:
cobra@eidebailly.com

Sales Assistance
If you would like to contact a sales team member, please call 612.253.6636.


State of Minnesota Forms

These materials are for employees of the State of Minnesota. If you are a Minnesota resident, but not an employee of the State, please see the 'Participant' forms.

2015

Enrollment Forms

Flexible Benefits Enrollment
Transit Enrollment

Change/Termination Forms

Change Form to Limited MDEA or HRA
Transit Change in Participation
Flexible Benefits Change in Participation

Reimbursement Forms

MDEA/DCEA/HRA Reimbursement
Transit Reimbursement

Other Forms

Direct Deposit
Lost Check Affidavit


2014

Enrollment Forms

Flexible Benefits Enrollment
Transit Enrollment

Change/Termination Forms

Change Form to Limited MDEA or HRA
Flexible Benefits Change in Participation
Transit Change in Participation

Reimbursement Forms

MDEA/DCEA/HRA Reimbursement
Transit Reimbursement

Other Forms

Direct Deposit
Lost Check Affidavit