Blue shield wellmark w2 box form 2026

1. Click ‘Get Form’ to open the blue shield wellmark w2 box form in the editor.
2. Begin by filling out your Employee Information. Enter your Name, Social Security Number, Home Address, City, State, and Zip Code accurately.
3. In the Employee Reimbursement Account Agreement section, indicate your contribution amounts for both Medical and Dependent Care Reimbursement Accounts. Make sure to select either General Purpose or Limited Purpose for the Medical Reimbursement Account.
4. If you wish to order a Blue Priority Flex Debit Card, check the appropriate box and provide the name of your spouse or dependent if applicable.
5. Complete the Automatic Reimbursement Authorization section if you want Wellmark to treat your medical claims as Medical Reimbursement Account claims. Ensure you understand the conditions outlined.
6. Fill out the Direct Deposit Authorization section with your bank details if you prefer direct deposit for reimbursements. Attach a voided check for verification.
7. Finally, review all entries for accuracy before signing and dating the Employee Authorization at the bottom of the form.

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