Implementation Documents

In this section, you’ll find all the documents needed to begin your Alerus implementation. Select the sections that match your benefits, download and complete the required forms, then email them along with any requested supporting documents to hwsetup@alerus.com.

Before Implementation Start Date	Action
2 months or by November 3, 2025	Health and welfare implementation client information form(s) submitted to Alerus. COBRA Implementation client information form(s) submitted to Alerus.
1.5 months or by November 13, 2025	Service agreements and banking agreements executed.
1 month	Enrollment data submitted to Alerus. COBRA takeover submitted to Alerus.

Health Savings Account (HSA)

HSA Implementation Information
Alerus Implementation Client Form
Employer W9
Premium Only Plan Document Questionnaire
(Only required if not also completing the Section 125 Plan Document Questionnaire)
HSA Enrollment Template
(Service Agreements are required to be fully executed before enrollment information is submitted to Alerus)
Alerus Benefits Access Authorization
(Optional: only needed if external parties outside of the Employer are being granted administrative access)

Flexible Savings Account (FSA)

FSA Implementation Information
Alerus Implementation Client Form
Employer W9
Section 125 Plan Document Questionnaire
FSA Enrollment Template
(Service Agreements are required to be fully executed before enrollment information is submitted to Alerus)
Alerus Benefits Access Authorization
(Optional: only needed if external parties outside of the Employer are being granted administrative access)

Commuter

- FSA Implementation Information
- Alerus Implementation Client Form
- Employer W9
- Commuter Plan Design Checklist
- Commuter Enrollment Template
  (Service Agreements are required to be fully executed before enrollment information is submitted to Alerus)
- Alerus Benefits Access Authorization
  (Optional: only needed if external parties outside of the Employer are being granted administrative access)

Health Reimbursement Arrangement (HRA)

HRA Implementation Information
Alerus Implementation Client Form
Employer W9
HRA Plan Document Checklist
Section 111 Medicare Secondary Payer Reporting Form
HRA Enrollment Template
(Service Agreements are required to be fully executed before enrollment information is submitted to Alerus)
Alerus Benefits Access Authorization
(Optional: only needed if external parties outside of the Employer are being granted administrative access)

Lifestyle Spending Account (LSA)

Alerus Implementation Client Form
Employer W9
LSA Plan Design Questionnaire
Section 111 Medicare Secondary Payer Reporting Form
Beneficial Ownership Certification Form
LSA Enrollment Template
(Service Agreements are required to be fully executed before enrollment information is submitted to Alerus)
Alerus Benefits Access Authorization
(Optional: only needed if external parties outside of the Employer are being granted administrative access)

COBRA

Alerus Implementation Client Form
Employer W9
COBRA Direct Bill Implementation Spreadsheet
COBRA Direct Bill LOA ACH Authorization Form
Carrier Notice of Administration Form
COBRA Takeover Template
(Service Agreements are required to be fully executed before takeover information is submitted to Alerus)
Alerus Benefits Access Authorization
(Optional: only needed if external parties outside of the Employer are being granted administrative access)

Direct Billing/Leave of Absence

Alerus Implementation Client Form
Employer W9
COBRA Direct Bill Implementation Spreadsheet
Leave of Absence Implementation Spreadsheet
Direct Bill LOA ACH Authorization Form
Carrier Notice of Administration Form
Public Sector Implementation Questionnaire
Direct Billing Takeover Template
(Service Agreements are required to be fully executed before takeover information is submitted to Alerus)
Leave of Absence Takeover Template
(Service Agreements are required to be fully executed before takeover information is submitted to Alerus)
Alerus Benefits Access Authorization
(Optional: only needed if external parties outside of the Employer are being granted administrative access)

Combined Benefits Enrollment Templates

Use the enrollment templates below when implementing multiple benefits with Alerus. If you are submitting more than one benefit, choose the template that matches the combination of benefits you are implementing. Submit all enrollments together using that single template. Service Agreements are required to be fully executed before enrollment information is submitted to Alerus.