Quick Forms

Flexible Spending Account

• 125Claim Form (FSA - DCAP and/or  HRA) - fillable
• 125Claim Form (HRA only) - fillable
• 125Claim Instructions
• Day Care Provider form

Desktop Claim Request Receipt Upload* »  

                 * New September 17th Release Enhancement includes: "Consumers will be able to upload a receipt while filing a claim instead of after a claim is filed. This enhancement simplifies the process by eliminating a step, and provides more efficiency for consumers to upload receipts."

Guidelines & Information

• Over the Counter (OTC) - New Changes 2011
• FSA Eligible Expenses (sample list)  and OTC rules for 2011
•  Over the Counter (OTC) New 2011 Changes and Debit Cards Use
• FSA Non-Eligible Expense Examples
• Health care Pricing Guide - 2011
• A Quick Guide for Reimbursement
• A Flexible Spending Account. Is it Right for You?
• Dependent Care vs. Dependent Tax Credit Guide - 2011
• Determine your Pre-Tax Election & Pay Check Savings (under Worksheet)
• Smart Money - WSJ 2011   "Cut Your Child - Care Costs"  (article and calculator)

Transportation Account

• Parking Reimbursement Form
• Transportation Personal Receipt
• What is eligible and what is not!

* Your Summary Plan Description (SPD) will describe your specific eligible claim types. If you have any specific questions, please contact your HR department or 125Company.

All forms are also available in your personal account login portal.

What Our Customers are Saying

Contact Us