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Public Employees Health Program, FLEX Claims Jordan School District 560 East 200 South, Suite 100, Salt Lake City, Utah 84102-2004 801-366-7503 TOLL FREE 800-753-7703 FAX 801-366-7772 TOLL FREE 800-759-8772
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The flex spending reimbursement form is a document used to request reimbursement for eligible expenses paid out of a flexible spending account (FSA).
Employees participating in a flexible spending account (FSA) are required to file the flex spending reimbursement form to request reimbursement for eligible expenses.
To fill out the flex spending reimbursement form, provide information about the expense, including the date, amount, and description. Attach any required documentation, such as receipts or invoices.
The purpose of the flex spending reimbursement form is to request reimbursement for eligible medical, dental, vision, or dependent care expenses paid out of a flexible spending account (FSA).
The flex spending reimbursement form should include details such as the date of the expense, the amount paid, a description of the expense, and any supporting documentation, such as receipts or invoices.
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