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FLEXIBLE SPENDING ACCOUNT FSA HEALTH CARE CLAIM FORM Plan Year 1/1/2017-12/31/2017 To request reimbursement from your FSA for a health care claim please Complete this form. This form is located at your online account myRSC. Please don t send original bills or receipts claims are stored electronically and paper forms and attachments are shredded. Submit this form to Regence Group Administrators RGA the administrator of your health plan by one of the following methods Mail RGA Attn FSA...
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What is to request reimbursement from?
Request reimbursement from is the process of asking for the return of funds that were previously spent.
Who is required to file to request reimbursement from?
Anyone who has incurred eligible expenses and is entitled to reimbursement must file to request reimbursement from.
How to fill out to request reimbursement from?
To fill out a request for reimbursement, one must provide detailed information about the expenses incurred, including receipts and supporting documentation.
What is the purpose of to request reimbursement from?
The purpose of requesting reimbursement is to recover funds that have been spent on eligible expenses.
What information must be reported on to request reimbursement from?
Information such as the date of the expense, the amount spent, the purpose of the expense, and any supporting documentation must be reported on the request for reimbursement.
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