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Flexible spending claim form

myuhc.com

FLEXIBLE SPENDING ACCOUNT.

MAIL CLAIM FORM TO: UnitedHealthcare PO Box 981178 El Paso, TX 79998-1178 Fax: (915) 781-1085 Phone: (877) 311-7849 FLEXIBLE SPENDING ACCOUNT (FSA) CLAIM FORM

provider.uhc.com

FLEXIBLE SPENDING ACCOUNT.

Policy Number: 100300 Fax: (518) 454-4844 Phone: 866-CAT-4215 MAIL or FAX CLAIM TO: FSA Unit - P.O. Box 925 Albany, NY 12201-0925 FLEXIBLE SPENDING ACCOUNT CLAIM FORM

cignaforhealth.com

Flexible Spending Account.

Flexible Spending Account (FSA) Reimbursement Form Please complete this form and mail or fax with supporting documentation to: CIGNA, Flexible Benefits Administration ...

flex-plan.com

Company Code COMPANY NAME.

2. Do not staple any documentation to claim form, please tape to separate sheet or include loosely in envelope. Do not send originals (all claims are stored ...

community.intuit.com

W-2 Box 10. Is flexible s.

Client has $1000 reported in box 10 of form W-2. He states this is his flexible spending account.

nhlgc.org

SCHEDULE A HEALTHCARE FLE.

HEALTHCARE FLEXIBLE SPENDING ACCOUNT List of Eligible/Ineligible Expenses ... Beginning January 1, 2011, OTC drugs and medicines are not eligible for FSA reimbursement ...

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