Payflex forms 2025

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The document is a Flexible Spending Account (FSA) Claim Form for Health Care and Dependent Care expenses, provided by PayFlex Systems USA, Inc. It outlines the process for submitting claims, including required information such as member identification, service details, and caregiver certification. The form emphasizes the need for supporting documentation to avoid payment delays and offers an online filing option. It also includes certifications regarding the eligibility of expenses and warnings against fraudulent claims.

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What is eligible for PayFlex?

You can use the card to pay for eligible expenses allowed under your plan. These generally include copays, prescriptions, vision and hearing products, and much more. To view a list of common eligible expenses, visit PayFlexDirect.com. Click on Employee Account Login.

How to submit claim to payflex HSA?

After you incur an eligible expense, you have the option of submitting a claim online using Express Claims or completing a paper claim form and mailing or faxing it along with receipts to PayFlex. Claims may be submitted anytime. (866) WEB-CLMS (932-2567).

Can I use PayFlex for groceries?

The PayFlex Card is accepted at all qualified healthcare merchants including physician and dental offices, hospitals, mail order prescription vendors, hearing and vision care providers. The card can also be used at discount stores, grocery stores, and pharmacies, provided the merchant has implemented an IIAS.

How do I verify my identity on Payflex?

If its your first ever time using Payflex, welcome! Well just need to iron out some small details (you know, the usual: name, mobile number, email address, and South African ID number) then well do a quick automatic credit and ID assessment to check that you are who you say you are and all that!

Where do I submit FSA receipts?

The best way to submit a receipt is through the online portal at or through the mobile app. You may also fax a scanned copy to (877) 723-0149.

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How do I submit documentation to PayFlex?

Go to payflex.com and click Documents Forms at the top of the page. Select Administrative Forms and click Flexible Spending Account Claim Form. Complete all fields of the form. Sign and date the form. Mail or fax your completed claim form and supporting documentation to PayFlex.

What is the tax form for PayFlex?

In May, well send you Form 5498-SA. You wont need to include that form when you file your taxes. Well send it to the IRS for you. Form 5498-SA includes pre-tax contributions from your paycheck, any contributions you made on your own (post-tax), and any employer contributions you received.

How do I get approved for Payflex?

All about Payflex Select Payflex at checkout. Enter your personal details name, email, cellphone number, SA ID number. Confirm your cellphone number Payflex will send you a one-time PIN via SMS. Payflex will complete an eligibility and credit check.

Payflex forms 2025

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What is eligible for PayFlex?

How to submit claim to payflex HSA?

Can I use PayFlex for groceries?

How do I verify my identity on Payflex?

Where do I submit FSA receipts?

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How do I submit documentation to PayFlex?

What is the tax form for PayFlex?

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