I have been a client of SOMI for almost 14 years. During that time, I never failed to be impressed with their resourcefulness and ability to help us solve what seemed to be intractable problems. Their service orientation is unsurpassed.
 Vice President of Human Resources & Administration

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Credit Authorization (Direct Deposit) Form(pdf - 293Kb)
Used when Flexible Spending Plan participants wish to receive their reimbursements via direct deposit. Please complete this form, attach a copy of a voided check and mail to SOMI.
Dependent Care Form(pdf - 218Kb)
Used for participants enrolled in their employers Dependent Care Reimbursement Plan and wishes to receive reimbursement for expenses and services.
Automatic Dependent Care Reimbursement Claim Form(pdf - 281Kb)
Used when participants who are enrolled in their employer's Dependent Care Reimbursement Plan wish to receive automatic reimbursement. Dependent Care must be provided on a regular basis and the cost of that care must be consistent throughout the plan year.
Flexible Spending Form (Flex Claims)(pdf - 256Kb)
For those participants enrolled in their employer's Flexible Spending Account (FSA) Plan and wish to receive reimbursement for expenses and services. For a list of eligible expenses, please see below.
Flexible Spending Orthodontic Reimbursement Form(pdf - 280Kb)
For those participants enrolled in their employer's Flexible Spending Account (FSA) plan and wish to receive automatic monthly reimbursement for Orthodontic expenses and services.
Flex Orthodontic Claims Instructions(pdf - 20Kb)
Before filing Orthodontic Claims for reimbursement from your Flexible Spending Account (FSA) please read these instructions.
Transportation Form(pdf - 226Kb)
For those participants enrolled in their employers Transportation Reimbursement Plan and wish to receive reimbursement for expenses and services.
List of Flex Eligible Over the Counter (OTC) Expenses(pdf - 40Kb)
For those participants enrolled in their employer's Flexible Spending Account (FSA) Plan, here is a partial list of Over The Counter (OTC) Expenses.
Sample Explanation of Benefits (EOB)(pdf - 129Kb)
For those particiapnts enrolled in their Employer's Medical or Dental Plan, here is a sample Explanation of Benefits (EOB).
HRA Claim Form(pdf - 254Kb)
For those participants enrolled in their employer's Health Reimbursement Account (HRA) Plan and wish to receive reimbursement for expenses and services.
Proof of Disability Form(pdf - 298Kb)
To be completed by all participants who are currently out on Short-Term Disability and SOMI is the Administrator of their Short-Term Disability Plan. If have you questions relating to the completion of this form please contact us via email at customerservice@somi.com
Request for Review of Benefit Denial(pdf - 122Kb)
For those participants who wish to appeal any decision not to provide you a service, or pay for an item (in whole or in part).
Appointment of Authorized Representative(pdf - 180Kb)
For those participants who wish to designate someone to act as your authorized representative and file an appeal on your behalf.