Get Sheakley Fsa

Filling out the Sheakley Flexible Benefits Division Health Care Reimbursement Claim Form online can streamline your reimbursement process and ensure you receive your benefits promptly. This guide will provide you with a step-by-step approach to complete the form accurately and efficiently.

Follow the steps to complete the Sheakley Fsa online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Part 1: Employee Information. Enter your first and last name, your social security number, your work phone number, and your employer's name. Also, provide your email address for correspondence.
3. If you have experienced an address change, complete Part 2 by filling in your new address, including street, city, state, and zip code.
4. Proceed to Part 3: Employee Certification for Reimbursement. Carefully read the certification statement, ensuring that you meet all requirements. Sign and date the certification to confirm the accuracy of your claims.
5. In Part 4: Itemized List of Expenses, list each service date for the expenses incurred. Include the requested amount for each item. Be sure to provide accurate service dates and amounts to avoid delays.
6. Ensure to check the box indicating whether you have a Health Savings Account (HSA). Understand the rules regarding overlapping expenses when participating in both a Flexible Spending Account (FSA) and an HSA.
7. Calculate the total amount requested, ensuring it meets the minimum claim amount of $25.00. Attach copies of all necessary supporting documentation for the items listed on the form.
8. Once you have completed all sections, review the form for accuracy. Save your changes, and choose to download, print, or share the completed form as needed.

Complete your Sheakley Fsa online today to ensure your medical expenses are reimbursed efficiently.