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Employee Signature Date Please return this form to CoreSource Attn FSA/HRA Department P. O. Box 8215 Little Rock AR 72221 Email address coreflex coresource. COREFLEX HealthCare Reimbursemnt Arrangement REQUEST FORM Phone 1-877-267-3359 Fax 1- 501-221-9074 PLEASE NOTE IF ADDRESS IS A NEW ADDRESS A. EMPLOYEE INFORMATION Name Social Security Number Employer Name Address ONLY IF NEW City State Home Phone/Cell Number optional Work Phone Number optional Email Address optional Zip B. HRA ACCOUNT Date of Service Provider of Service Person for Whom Service Provided Relationship to You TOTAL AMOUNT REQUESTED D. CERTIFICATION Amount I certify that the following is true 1. The expenses listed above were incurred by me and/or my eligible dependents and qualify for reimbursement within the current plan year. 3. I have not and will not deduct the above listed expenses on my Federal Income Tax returns. 4. The appropriate Explanation of Benefit Statements from the insurance are attached* Please keep co....

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Established in 1913, the company provides life, health, and accident insurance services to its clients. The company operates as a subsidiary of Trustmark Mutual Holding Company (Trustmark Companies). The assets of the firm are managed by the executive management team.

Coresource is a health insurance company that provides self-funded employee benefit plans. Patients that are enrolled in a Coresource insurance plan may have some or all of their treatment costs covered by their health insurance during their stay at Garden State Treatment Center.

January 1, 2020: myCoreSource.com is changing to myTrustmarkBenefits.com.

History. Trustmark was founded in 1913 as the Brotherhood of All Railway Employees, and later in 1917 adopted the name Benefit Association of Railway Employees. In 1963 the company became Benefit Trust Life Insurance Company.

“CoreSource has been an Aetna Signature Administrator since 2004 and, as our largest TPA relationship, has been integral in helping us achieve growth in the self-insured space. The contract extension demonstrates our long term commitment to our relationship with CoreSource as an Aetna Signature Administrator.”

As an independently operating subsidiary of Trustmark Companies, CoreSource has the support of an A-category rated mutual insurance company.

Trustmark, the parent company of CoreSource, has been providing the kind of financial security that has helped businesses and families realize their own visions and dreams.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232