Get Flexelect Form

Completing the Flexelect Form online is a vital part of managing your flexible spending account. This guide will provide clarity on how to efficiently fill out each section of the form to ensure you complete your reimbursement claims accurately.

Follow the steps to fill out the Flexelect Form correctly.

1. Click ‘Get Form’ button to obtain the form, which you will need to have readily accessible in the editor for filling out.
2. Begin by entering your personal information, including your last name, first name, and middle initial. Make sure to provide your Social Security number and a daytime phone number for any necessary follow-ups.
3. Proceed to the address section where you will include your street address along with your city, state, and zip code.
4. For the Dependent Care Reimbursement Account section, fill in the name and age of your dependent, the dates care was provided (from and to), and the care provider's name, address, and Taxpayer Identification Number. Specify the total cost for the care period.
5. Sign the Care Provider's signature line and enter the date to acknowledge the expenses incurred for the dependent care.
6. Switch to the Medical Reimbursement Account section. Here, enter the date of medical care provided, the name of the medical provider, and a description of the medical expense, including the individual for whom the expense was incurred.
7. Enter the total medical amount requested and specify the relationship of the individual related to the claim.
8. Attach a detailed statement of services or insurance explanation of benefits for each expense you are claiming, ensuring it meets the required documentation guidelines.
9. Review your completed form for accuracy and sign it to certify all submitted claims are valid and incurred during your coverage period.
10. Finally, save your changes. You may then choose to download, print, or share the completed form as needed. Ensure all supporting documentation is included if mailing or faxing your claims.

Start completing your Flexelect Form online to ensure timely processing of your claims.