Please see Plan Documents to find the Enrollment form. You will need to make sure that you fill out an enrollment form and we have it on file.
When filing a claim please read the second page of the claim form for the directions and information needed to process the claim.
Please note you must have current Medical insurance to file a claim for reimbursement.
Please note there is a 2% processing fee applied to all reimbursement claims. This amount is deducted from the payout amount.
Example : you send in a claim for $200.00 the claim fee for this is $4.00 and your check amount will be $196.00.
The deadline for submitting a claim for 2025 plan year is June 15th 2026.
The deadline has past for filing a claim for any other previous plan years.
All requests for Reimbursement require a claim form!
You can mail in the claim form and supporting documents to the address provided. If you would like to fax the claim in it must be legible and have a completed claim form with it. If you would like a digital link to upload to us you will need contact our office to request this service as it requires a couple of extra steps.