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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 Please complete the information on the other side of this page and review the following reminders to ensure accurate and timely processing of your request Is your Participant ID number included on the form Is your Employer Name and FSA Group Number included on the form You can find FSA Group Number printed on your FSA Explanation of Benefits EOB...
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What is flexible spending form?
Flexible spending form is a document used to track and report expenses paid for with pre-tax dollars from a flexible spending account (FSA).
Who is required to file flexible spending form?
Employees who have a flexible spending account are required to file flexible spending form.
How to fill out flexible spending form?
To fill out flexible spending form, employees must itemize their expenses paid with pre-tax dollars from their FSA account.
What is the purpose of flexible spending form?
The purpose of flexible spending form is to document and report expenses paid for with pre-tax dollars from a flexible spending account.
What information must be reported on flexible spending form?
Information such as date of expense, type of expense, amount paid, and proof of payment must be reported on flexible spending form.
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