TrustSecure

Forms

Employee Forms

All forms are Adobe PDF unless noted otherwise.

Direct Deposit Form. After you have left employment and are eligible to receive reimbursement for qualified medical expenses, complete this form if you would like your TrustSecure reimbursements deposited directly into your checking or savings account.

Eligible Expenses. This is a representative list of IRS-qualified expenses that can be reimbursed from your TrustSecure account. It is not an all-inclusive list. Please refer to IRS Publication 502 for a list of the medical and dental expenses for which you may receive reimbursement.

Participant Enrollment and Change Form. Use this form to establish your TrustSecure account or to report any subsequent changes to your account after it has been established.

Letter of Medical Necessity. You must have your attending physician complete this form for you if you are requesting reimbursement for items with an asterisk next to them as listed on the Eligible Expenses list. If you need a particular item on an ongoing basis, medical necessity will need to be established on an annual basis.

Reimbursement Claim Form. To receive reimbursement through your TrustSecure account for qualified medical expenses, complete this form, attach all appropriate receipts or an explanation of benefits form, and send it to EBC. Be sure to retain a copy of these items for your personal records.

Suspension Election Form. Complete this form to suspend your ability to receive reimbursements from your TrustSecure account for qualified medical expenses if you are contributing to a Health Savings Account in a given tax year.

Employer Forms

Access your account

TrustSecure is a medical expense reimbursement plan established by WEA Trust and administered by Educators Benefit Consultants, LLC (EBC).