Get Flex Spending Claim Form - Midwest Group Benefits

Filling out the Flex Spending Claim Form accurately ensures you receive timely reimbursement for your eligible expenses. This guide provides a clear, step-by-step approach to completing the form online, making the process straightforward and user-friendly.

Follow the steps to complete your Flex Spending Claim Form

1. Press the ‘Get Form’ button to access the Flex Spending Claim Form and open it in your preferred editor.
2. Begin by entering your Employee Information. Fill in your employer's name, your full name, and your Social Security number. Indicate if you have a new address by selecting 'Yes' or 'No.' Provide your current address details.
3. Move on to the Health Claims section. If you are filing for expenses covered by your insurance, attach a copy of the Explanation of Benefits from your insurer. If you are submitting expenses that are not covered, include an itemized bill with the required information. It’s important that you do not include any cancelled checks as part of this documentation.
4. List the Patient Name(s) for the expenses claimed, along with their relation to you. Clearly describe the service provided, the name of the provider, and the service dates.
5. For each service, indicate the total amount incurred. Sum all amounts to show the grand total for this section.
6. Next, complete the Dependent/Child Care Claims section. If your provider has signed, you will not need any additional receipts. Otherwise, attach a proper receipt and ensure it includes your provider’s name, address, and tax identification number.
7. Fill in the dependent’s name, age, and the provider’s tax identification number. Ensure the address of the provider is complete, and provide the provider’s signature.
8. Document the service dates and amounts incurred for dependent care as you did with health claims.
9. Finally, review the entire form for accuracy. Sign the Participant's Signature field, confirming that all claimed expenses are legitimate and qualify for reimbursement.
10. After completing the form, you can save your changes, download a copy for your records, print it out, or share it with the appropriate office.

Start completing your Flex Spending Claim Form online today to ensure you receive your reimbursement efficiently.