Fsa hhbenefits com get 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part I: Employee Information. Fill in your employer's name, your full name, Social Security Number, address, daytime phone number, and email address. If you have a new address, check the corresponding box.
3. Move to Part II: Health Care Claims. Indicate whether the expenses are covered by insurance or not. For covered expenses, attach the Explanation of Benefits (EOB) from your insurance company along with any necessary itemized statements.
4. For non-covered expenses, provide an itemized statement from your service provider that includes their name and address, patient name, date of service, description of service, and amount charged.
5. In Part III: Dependent Child or Adult Day Care Claims, complete the required information about your day care provider and attach an itemized statement if necessary. Ensure all dates and amounts are accurately filled out.
6. Finally, certify that all expenses are eligible by signing and dating the form at the bottom before submitting it through our platform.

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