FORMS
Forms
Welcome to the forms section! Here you will find the most commonly used forms for the benefit plans offered at JFS. If you still cannot find what you need after reviewing this section, please contact the Benefits Helpline for assistance.
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Medical Plan Forms
Principal - Dental, Life and Disability Enrollment Kit with Forms
Vision Plan Forms
Flexible Spending Plan Forms
Life and Disability Forms
Health Reimbursement Arrangement Online Form Summary
Health Reimbursement Arrangement Summary
PacificSource offers several ways you can submit your claims for reimbursement:
1. Submit your claim online using our PSAConsumer portal: https://psa.consumer.pacificsource.com
2. Submit your claim via our Mobile App: myPacificSource Admin (PSA)
3. Mail or fax a Request for Reimbursement Form. You’ll find the form at PSA.PacificSource.com/ Forms_Flex.aspx