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REIMBURSEMENT REQUEST Formal completed form to:Maritain Health P.O. Box 30111 Lansing, MI 48909Fax to: Customer Service:888.837.3725 800.566.9305Employer Name: Employee Name:SS# or ID#:Address:Telephone
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What is fsa claim formmi2018?
FSA Claim Formmi2018 is a form used to file for reimbursement of eligible expenses under a Flexible Spending Account for the year 2018.
Who is required to file fsa claim formmi2018?
Employees who contributed to a Flexible Spending Account in 2018 and incurred eligible expenses that they wish to be reimbursed for.
How to fill out fsa claim formmi2018?
Fill out the form with your personal information, details of the expenses being claimed, and any required documentation. Submit the form to the FSA administrator for processing.
What is the purpose of fsa claim formmi2018?
The purpose of FSA Claim Formmi2018 is to request reimbursement for eligible expenses paid out of pocket using funds contributed to a Flexible Spending Account in the year 2018.
What information must be reported on fsa claim formmi2018?
The form requires details of the expenses being claimed, including the date, amount, and nature of the expense. Additionally, any required documentation must be provided.
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