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  • Allegiance Reimbursement Form

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P. O. Box 4346, Missoula, MT 59806 HEALTH FLEXIBLE SPENDING ACCOUNT (FSA) REIMBURSEMENT REQUEST To send scanned claims, or for additional forms, go to: www.allegianceflexadvantage.com FAX: 406-523-3149.

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For answers to other questions please contact Customer Service at (800) 735-1923.

If you do not file a written request for review within 180 days, your request for review will be denied.

What We Do. Allegiance Benefit Plan Management, Inc., develops and administers employee benefit plans for companies, associations and government agencies.

Allegiance offers third party administration of Flexible Benefits Plans (FSAs), Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs), and qualified transportation plans (Parking and Mass Transit). We place priority on accurately processing claims and reimbursing members promptly. Submit a Claim.

Allegiance became a wholly-owned subsidiary of Cigna in 2008 enabling us to offer the flexibility and customized service of our TPA model alongside Cigna's extensive network and analytic products.

If you do not file a written request for review within 180 days, your request for review will be denied. Your request should contain the reasons why you do not agree with the Plan's decision along with any additional documentation you would like the Plan to review to provide full and fair reconsideration of the claim.

Claim status information or verification of benefits may be obtained 24 hours a day by accessing our website at .askallegiance.com or our Interactive Voice Response (IVR) system at (406) 523-3199. For answers to other questions please contact Customer Service at (800) 735-1923.

Allegiance, a Cigna company, is working with your employer to offer you a cost-effective self-funded option that provides you and your elected dependents with the basic coverage that is needed to help you stay well.

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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