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 and 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.