Quick Forms


Flexible Spending Account

FSA_DCAP_HRA_Claim Form

Dependent Care Overview

Claim Rules and Filing Instructions *

Authorization for Direct Deposit

Day Care Provider Receipt

HIPAA Release of Information

Letter of Medical Necessity _ 2016

 

* Medical Expense Sample Worksheet

 

According to the IRS Website "You must keep records as long as they may be needed for the administration of any provision of the Internal Revenue Code. Generally, this means you must keep your records that support your deduction (or an item of income) for 3 years from the date you file the income tax return on which the deduction is claimed." For more information on tax filing, please check with your accounting professional.

 

Guidelines & Information

 

 

 

 

 

 

 

HSA Consumer Notice Regarding Electronic Delivery of Tax Forms 2017 120915

 

 

 

New Educational Tools and Resources

 

 

 

 

Quick Link: "Desktop Claim Request Receipt Upload"  

 

Transportation Account

 

         "Transportation Changes for 2016"

 

* Your Summary Plan Description (SPD) will describe your specific eligible claim types. If you have any specific questions, please contact your HR department or 125Company.

 

All forms are also available in your personal account login portal.

 

 

 

 



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Phone: (301) 977-8840
Toll Free number (877)-303-3539
General Fax: (301) 977-9337
Claim Fax: (877) 303-0742
Email Customer Support
Desktop Claim Requested Receipt Upload

New Employer Administrative Services Inquiry

Claim and Correspondence mailing address:

PO Box 2401 Germantown MD 20875-2401