Get Pehp Flex

Filling out the Pehp Flex form online can be a straightforward process when you have the right guidance. This document serves as a comprehensive guide to assist you in effectively completing the Pehp Flex form, ensuring you provide accurate information for your claims.

Follow the steps to fill out your Pehp Flex form effectively

1. Press the ‘Get Form’ button to access the Pehp Flex form and begin filling it out in the designated editor.
2. Provide your employee information including your full name (last, first, middle initial), home address, ID number, plan year, city/state/zip code, and daytime phone number. Ensure all sections are accurately filled out as this information is essential for processing your claim.
3. In the qualified health care expenses section, list each claim item in order. For each claim, fill in the item number, name of provider, date of service, expense description, and claim amount. Be sure to include all relevant documentation, such as an Explanation of Benefits or receipts.
4. If claiming orthodontia expenses, attach the required written agreement, ensuring that it includes total estimated charges and the treatment period. Also, verify if a doctor’s note is necessary based on the FLEX$ handbook.
5. Complete the total claim amount at the end of the qualified health care expenses section, summarizing the total claims you are submitting.
6. In the qualified dependent day care expenses section, document the same categories: item number, date of service, name of provider, provider tax ID/SSN (which is required), and claim amount.
7. Summarize the total claim amount for dependent care expenses similarly.
8. Read the certification statement carefully. Acknowledge that the expenses claimed are qualified and that they have not been submitted for reimbursement through any other means. Sign and date the form to confirm your submission.
9. Once all fields are completed and verified, save your changes, and proceed to download, print, or share your completed form as needed.

Complete your Pehp Flex form online today for efficient processing of your claims!