New FBC HSA Enrollment

STEP 1: Owner & Company Details

Business Owner



Becomes the login username

mm/dd/yyyy

Example format: 403-123-4567

Dependant


Enter in mm/dd/yyyy format


5 digit FBC member number


Your legal business name

Determines what HSA products are available or required




Format Example: T2V 1X4

Example format: 403-123-4567

Alternate Plan Admin



Becomes the login username
​For assistance, please call​ ​toll-free​ ​1(844)​ ​FBC-DESK​ ​(844-322-3375)​.  Also, check out ​​our support center.

STEP 2: Healthcare Spending Account Setup


The benefit year based on any 12 month period.

Incorporated Company Annual Limits
Your annual limit is an amount you choose that is reasonable to cover to your health and dental expenses. Typical FBC members use a 10,000 annual limit however, any reasonable amount can be used. 

Any amount can be entered.

Any amount can be entered.
Sole Proprietor/Partnership Annual Limits
Your annual limit is an amount you choose that is reasonable to cover to your health and dental expenses. Typical FBC members use a 10,000 annual limit however, any reasonable amount can be used. 

$1500 max.

$1500/adult and $750/child max. (Ex:  2 Adults & 1 Child = $3,750 max)

STEP 3: Plan Authorization

By checking the box above, the business agrees to provide a Health Spending Account for its employees and will pay for all account funding and administration fees as required. This enrollment form establishes a contract of Insurance (copy available online for Company Administrator).

Contact Information