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Order open enrollment materials

If you would like to order PayFlex® flyers for your open enrollment, complete the form below. Please note; we require a 10-day lead time from the date you place your order to the date you receive your materials.

Step 1 of 5

Contact Information

* Indicates required field

Client name*


Please Enter Client name

Client phone number*

- -
Please Enter Client phone number

PayFlex Account Manager*


Please Enter PayFlex Account Manager

Requested by*


Please Enter Requested by

Requestor’s email address*

This person will receive a shipment notification once materials are mailed.


Please Enter Requestor's email address Please provide a valid email address

Requestor’s phone number*

- -
Please Enter Requester's phone number
Are you using these materials for a benefit fair or enrollment meeting? Are you using these materials for a benefit fair or enrollment meeting? *  Yes  No
Please Select an Option
Step 2 of 5 * Indicates required field

Shipping Information

Company name*


Please Enter Company name

Attention*


Please Enter Attention

Address*

Please Enter Address

City*


Please Enter City

State*


Please Select State

Zip Code*


Please Enter Zip Code

Comments / Special Instructions

When would you like to receive these materials?

(We require a minimum 10-day lead time)

"  

MM/DD/YYYY

We require a 10-day lead time. Please provide a date that is at least 10 days from today. Date must be in MM/DD/YYYY format.
Step 3 of 5

Member Flyers

Enter quantities below.

  • Only enter quantities for the services you offer your employees.
  • Only order materials for 30% of your eligible employee population.
  • The maximum number of materials you can order is 2,000. If you want to order more, contact your PayFlex Account Manager.

Note: You can view member flyers listed by product under open enrollment toolkit.

Health Savings Account

Quantity
Health Reimbursement Arrangement
Quantity

Health Savings Account Investments

Quantity
Limited Health Reimbursement Arrangement
Quantity

Health Savings Account CIP

Quantity
Retiree Reimbursement Arrangement
Quantity
Health Savings Account & Limited Purpose Flexible Spending Account
Quantity
Commuter Benefits Online Solution
Quantity
Flexible Spending Account - health care + dep care
Quantity
PayFlex Card
Quantity
Flexible Spending Account - health care + dep care (no PayFlex card)
Quantity
Keep Your PayFlex Card Active
Quantity
Limited Purpose Flexible Spending Account
Quantity
Connected Claims
Quantity
Limited Purpose Flexible Spending Account (no PayFlex card)
Quantity
Connected Claims (no PayFlex card)
Quantity

844-PAYFLEX (2”x 4” contact card)
Quantity
The maximum number you can order for each flyer is 2,000. Please enter a lower quantity. If you want to order more than 2,000, contact your PayFlex Account Manager.
Step 4 of 5

Spanish Member Flyers

Spanish Health Savings Account

Quantity

Spanish PayFlex Card

Quantity
Spanish Flexible Spending Account (includes health care & dependent care)
Quantity

Spanish Commuter Benefits Online Solution

Quantity
The maximum number you can order for each flyer is 2,000. Please enter a lower quantity. If you want to order more than 2,000, contact your PayFlex Account Manager.
Step 5 of 5

PayFlex Giveaways

Enter quantities below.

  • Only order 15% of your eligible employee population.
  • The maximum number of giveaways you can order is 2,000. If you want to order more than that amount, contact your PayFlex Account Manager.

PayFlex Giveaways

Quantity
The maximum number of giveaways you can order is 2,000. Please enter a lower quantity. If you want to order more than 1,000, contact your PayFlex Account Manager.
Confirmation

Thank you for your order! Your materials should arrive by 02/09/2023

Print this confirmation for your records.

Date ordered: 01/30/2023


Shipping Information:

Attention:
Email:
Address:

Contact Information:

Attention:
Email:
Address:

Materials Ordered Quantity

To order materials for an additional location, please place another order.

Contact a PayFlex Advocate

1-844-PAYFLEX
(1-844-729-3539)(TTY: 711)
Monday - Friday, 7:00 am - 7:00 pm (CT)
Saturday, 9:00 am - 2:00 pm (CT)