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FLEXIBLE SPENDING ACCOUNT (FSA) WITHDRAWAL REQUEST P.O. Box 42096 Oklahoma City, OK 73123-3096 Phone: 405-848-1975 Fax: 405-858-1125 PART 1. Employee Information (Please Print) EMPLOYEE NAME (Last
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What is flex plan claim?
Flex plan claim is a request for reimbursement of eligible expenses incurred by an individual under a flexible spending account (FSA) or a health reimbursement arrangement (HRA) plan.
Who is required to file flex plan claim?
Employees who have enrolled in a flexible spending account (FSA) or a health reimbursement arrangement (HRA) plan are required to file flex plan claims.
How to fill out flex plan claim?
To fill out a flex plan claim, you need to complete the claim form provided by the FSA or HRA plan administrator. The form typically requires you to provide details of the expenses, such as the date, description, and amount, along with any supporting documentation.
What is the purpose of flex plan claim?
The purpose of a flex plan claim is to request reimbursement for eligible expenses that were paid out-of-pocket by the employee and are covered under the FSA or HRA plan.
What information must be reported on flex plan claim?
The flex plan claim typically requires you to report information such as the date of the expense, the description of the expense, the amount spent, and any supporting documentation such as receipts or invoices.
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