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Flexible spending claim form

FLEXIBLE SPENDING ACCOUNT (FSA) CLAIM FORM

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

myuhc.com
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FLEXIBLE SPENDING ACCOUNT CLAIM FORM

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

provider.uhc.com
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Flexible Spending Account (FSA) Reimbursement Form Please complete ...

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

cignaforhealth.com
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Company Code COMPANY NAME: FLEXIBLE SPENDING ACCOUNT CLAIM FORM ...

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 ...

flex-plan.com
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W-2 Box 10. Is flexible spending account reported here? | Intuit ...

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

community.intuit.com
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SCHEDULE A HEALTHCARE FLEXIBLE SPENDING ACCOUNT

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

nhlgc.org
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Changes in Health Care Flexible Spending Accounts

Care Flexible Spending Accounts (FSA) beginning in January of 2011. Over the counter (OTC) drugs, medicines ... medications from the list of eligible expenses that can be ...

benefithelpsolutions.com
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