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  • Exxonmobil Aetna Flexible Spend Form

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Your claim submission is for more than three family members, please submit a separate claim form for the additional family members. - Explanation of Benefits (EOB) statement indicating amounts paid by the medical or dental plan. For HMO s, submit evidence of payment only. Call Aetna s Automated Voice Response Unit at 800-255-2386 to get instant account balance and claim payment information from 8:00 a.m. to 9:00 p.m. ET. - Copy of the copayment receipt from the provider when the copayment.

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Log in to the FSAFEDS app using the same username and password as your online account. Select whether to submit a claim or pay a provider. Follow the prompts to enter claims details. Take photos of your itemized receipts (and other documentation if needed) or upload from your mobile device.

Use the money in an FSA to cover eligible: Health care expenses, such as out-of-pocket costs. Dependent care expenses, such as work-related child care.

What Are My FSA Eligible Expenses? The IRS determines which expenses are eligible for reimbursement. Eligible expenses include health plan co-payments, dental work and orthodontia, eyeglasses and contact lenses, and prescriptions. This type of FSA is offered by most employers.

An arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. Allowed expenses include insurance copayments and deductibles, qualified prescription drugs, , and medical devices.

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).

Send completed form and documentation to: Aetna FSA. P.O. Box 4000. Richmond, KY 40476-4000. Fax to: 1-888-238-3539 (1-888-AET-FLEX) For the hearing impaired, call 1-877-703-5572 TDD/TTY.

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© Copyright 1997-2025
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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