Quick Forms

Flexible Spending Account


Dependent Care Overview

Claim Rules and Filing Instructions *

Authorization for Direct Deposit

Day Care Provider Receipt

HIPAA Release of Information

Letter of Medical Necessity _ 2018


* Medical Expense Sample Worksheet


According to the IRS Website "You must keep records as long as they may be needed for the administration of any provision of the Internal Revenue Code. Generally, this means you must keep your records that support your deduction (or an item of income) for 3 years from the date you file the income tax return on which the deduction is claimed." For more information on tax filing, please check with your accounting professional.


Guidelines & Information








HSA Consumer Notice Regarding Electronic Delivery of Tax Forms 2017




New Educational Tools and Resources





Quick Link: "Desktop Claim Request Receipt Upload"  


Transportation Account


         "Transportation Changes for 2018"


* 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.





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Phone: (301) 977-8840
Toll Free number (877)-303-3539
General Fax: (301) 977-9337
Claim Fax: (877) 303-0742
Email Customer Support
Desktop Claim Requested Receipt Upload

New Employer Administrative Services Inquiry

Claim and Correspondence mailing address:

PO Box 2401 Germantown MD 20875-2401