Get Medical Claim Form - My Fsa Link

Filling out the Medical Claim Form - My FSA Link online is a straightforward process that helps ensure you receive reimbursement for eligible medical expenses. This guide will walk you through each section of the form, providing clear instructions to facilitate a smooth submission.

Follow the steps to complete your Medical Claim Form online effectively.

1. Press the ‘Get Form’ button to access the Medical Claim Form - My FSA Link and open it in your preferred editor.
2. Complete the top portion of the form by entering your employer name, employee name (specifically your last name), and the last four digits of your Social Security number.
3. Input your new address and email address in the designated fields to ensure proper communication regarding your claim.
4. List the eligible expenses by providing the date of service, a brief description of the service provided, and the reimbursement amount you are requesting.
5. If applicable, include the difference between the total expense and the amount paid if you have an explanation of benefits form to attach.
6. Sign and date the form at the bottom to certify the information provided is accurate and that the expenses have not been reimbursed elsewhere.
7. Attach the necessary documentation to support your claim. This may include an explanation of benefits from your insurance or itemized receipts for expenses not covered by a plan.
8. Once all information has been entered and documentation attached, submit the completed form to Benefit Tax Link via fax or email.
9. You have the option to save changes, download, print, or share the completed form based on your submission method.

Take the next step in managing your healthcare expenses by completing your Medical Claim Form online today!