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  • Primeflex Spending Forms

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Office Use Only Date Processed: Processed by: / Client #: / Reimbursement Claim Form Dependent Care Expenses PLEASE COMPLETE THIS FORM AND FAX IT ALONG WITH COPIES OF YOUR RECEIPTS TO PRIMEFLEX AT.

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Related content

Flexible Spending Account (FSA) - ASIFlex - DHR...
On May 12, 2020, the IRS issued a notice allowing employers greater flexibility when...
Learn more
How to File an FSA Claim
o Or Mail your claim form and explanation of benefits to: PrimeFlex – FSA Claims. 1487...
Learn more

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Submit Your Claim in One of These Ways Log in to your account. ... Once you have logged into your account, click Submit Receipt or Claim and select your Reimbursement Option. Follow the step-by-step instructions. Upload digital copies of your itemized receipts (and other documentation if needed).

Our Mobile App and Wealthcare Portal make manual claims submission easy! To learn more, check out our participant video library at support.primepay.com or contact us at (877) 769 - 3539 or primeflex@primepay.com.

Note: Alternatively, you can send an email to tlm@primepay.com or call 1-877-479-2992 for PrimePay support.

The Benefits Card is a signature based debit card and can be used as either credit or debit at the terminal or point of sale. There is a PIN associated with the card which can be found online. If you don't have your PIN available, you may choose the signature option at the time of purchase.

You may receive a PrimeFlex debit card which can be used to pay for eligible medical expenses at health care related providers such as physicians, pharmacies, dentists, optometrists, hospitals, etc. as well as non-health care related merchants such as grocery stores, discount stores and on-line pharmacies.

This account allows you to set aside money pre-tax in order to pay for your individual medical insurance premiums not covered by your Employer. Life insurance premiums, long-term care premiums and COBRA premiums are not eligible expenses under a Premium Reimbursement Account.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232