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Letter of Medical Necessity (For use with Flexible Spending Accounts) Employee Information: Hennepin County Patient Name Employer Employee Name Employee Social Security Number This form should be
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Start by gathering all the necessary information needed to complete the form. This may include personal details like name, contact information, and address, as well as any specific details related to using or applying for the flexible service.
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Flexible spending accounts (FSAs) are for use with flexible spending of pre-tax dollars for eligible expenses such as medical, dental, prescription, and vision.
Employees who wish to participate in a flexible spending account are required to file for use with flexible.
Employees need to consult their employer's HR department or benefits administrator to fill out the necessary paperwork for a flexible spending account.
The purpose of a flexible spending account is to allow employees to set aside pre-tax money to pay for eligible expenses, thus reducing their taxable income.
Information such as the employee's name, contribution amount, eligible expenses, and receipts must be reported on for use with flexible.
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