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Payflex Reimbursement Accounts Enrollment Form - Amazon S3 2025

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The document is an enrollment form for Reimbursement Accounts, specifically for Health Care Flexible Spending Account (FSA) and Dependent Care Flexible Spending Account (DCFSA). It includes sections for personal information, election choices regarding participation in the benefit plans, and pre-authorization for direct deposit of reimbursements. The form outlines contribution limits, conditions for changing elections, and responsibilities related to claims and reimbursements.

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How to get reimbursed from HSA Payflex?

To get reimbursed through your HSA, you must use the Make a Withdrawal feature. From the Financial Center, select File a Claim. Select your employer (if applicable) and your expense type. In the Expense Start Date field, enter the date of service or purchase.

How do I get reimbursed from Payflex?

Log in to pebc.payflex.com and under Account Actions select File a claim. Then complete the required fields to quickly file your claim. Paper Claim Filing: If you prefer to file your claim manually, follow these steps. Claim forms are available on pebc.payflex.com.

How do I submit a reimbursement claim?

How to Raise a Reimbursement Health Insurance Claim Intimate the insurance company. Pay bills and collect documents. Submit the claim form and documents. Let the insurance company verify and enquire.

How do I get reimbursed for FSA purchases?

Pay some other method (credit card, cash etc) then submit a claim to the FSA. You submit the bill (ie what you paid for) and the receipt that proves you paid for it. They will reimburse you by subtracting from your FSA balance and transferring the $$ directly to you.

Can I get my money back from Payflex?

All refunds will reflect in your Payflex Wallet as soon as it has been processed by the merchant. You can use your Wallet balance against future Payflex purchases or withdraw the funds immediately into your account via the Payflex Customer Portal, after which the funds will reflect in your bank account within 24 hours.