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Get Fsa Claim Form For Plan Year 2016 - Home - Navia
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How to fill out the FSA Claim Form For Plan Year 2016 - Home - Navia online
Filling out the FSA Claim Form can seem daunting, but with clear instructions, you can navigate the process with ease. This guide will walk you through each section of the form, ensuring that you understand how to complete it accurately and efficiently.
Follow the steps to successfully complete your claim form.
- Press the ‘Get Form’ button to access the FSA Claim Form and open it for editing.
- Begin with Section I – Employee Information. Fill in your last name, first name, middle initial, address, city, state, zip code, phone number, and email. If your address has changed, check the ‘Address Change’ box.
- Proceed to Section II if you are enrolled in the Day Care Assistance Program (DCAP). Fill in the start and end dates of care, provider’s name and contact information, dependent’s name and age, and the cost for the care period. Ensure to attach the necessary documentation as specified.
- For Section III, if you are enrolled in the Medical FSA, provide the service dates, type of service, name of the provider, and for whom the service was provided. Indicate if you used your debit card for any of these expenses.
- Complete Section IV by signing the claim form. Make sure to date your signature and review all statements to confirm their accuracy. Keep in mind that you must send your completed form via fax, email, or mail, but not through multiple methods.
- Once you have filled out all necessary sections and attached the required documentation, you can save changes, download, print, or share the form as needed.
Complete your FSA Claim Form online today and ensure your claims are submitted accurately.
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Usually, money that goes unused in an FSA account is forfeited at the end of the calendar year (except for the COVID-19 changes for 2021 and 2022). But some plans offer a grace period or acarryover. A grace period is a set amount of time during which the employee may submit a claim beyond the calendar year.
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