Flexfacts phone reimbursement form 2026

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3.9 out of 5

46 votes

The document is a Flexible Spending Account Claim Form that provides instructions for submitting claims for medical, dependent care, HRA, transit, or parking expenses. It requires personal information from the claimant, details about the expenses being claimed, and certifications if receipts are unavailable. The form emphasizes that claims must be for eligible expenses incurred during the plan year and outlines the process for reimbursement.

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Click ‘Get Form’ to open the flexfacts phone reimbursement form in the editor.
Begin by filling out your personal information. Enter your full name, employer, social security number, phone number, and email address in the designated fields.
If your address has changed, provide the new address along with the city, state, and zip code.
In the Claim Information section, specify the type of expense (Medical FSA, Dependent Care FSA, HRA, Transit or Parking) and enter the corresponding amounts for each type of expense listed.
For dependent care or transit certification, complete the provider's name and service start and end dates. If applicable, include the provider's tax ID number and obtain their signature.
Finally, sign and date the form to confirm that you agree to have your account reduced by the requested amount.

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Versions	Form popularity	Fillable & printable
2018	4.2 Satisfied (36 Votes)
2010	3.9 Satisfied (46 Votes)

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What are eligible expenses for Flexfacts?

You can access your account information on-line 24/7 at .flexfacts.com or between 8:30 AM and 8:30 PM EST by calling 877-94-FACTS (877-943-2287).

What are eligible items for Flex facts FSA?

Eligible expenses include deductibles, co-pays, vision, dental and prescriptions as well as any other medically necessary items that are not covered by insurance.

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