Medcom flex 2026

1. Click ‘Get Form’ to open the medcom flex claim form in the editor.
2. Begin by entering your Employee Name and Social Security Number in the designated fields. If you have changed your name, please include your former name as well.
3. If applicable, update your address by filling in the new street, city, state, and zip code.
4. Attach necessary substantiation documents for your claims. For medical expenses, include an Insurance Explanation of Benefits (EOB) or a medical provider invoice. For dependent day care claims, ensure invoices are itemized with required details.
5. Indicate the total amount for Medical Expenses and Dependent Day Care Expenses in their respective fields.
6. Answer the two questions regarding payment frequency and workdays during the claim period. Provide details as needed.
7. Itemize and total your expenses in the provided table, including provider information and incurred dates.
8. Finally, review your entries for accuracy, sign the form, and date it before submitting through mail, fax, or email as indicated.

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