Get Uniaccount

Filling out the Uniaccount is a straightforward process that allows users to submit claims for flexible spending accounts. This guide will provide you with clear instructions for each section of the form, ensuring a smooth online experience.

Follow the steps to complete your Uniaccount effectively.

1. Click ‘Get Form’ button to access the Uniaccount document and open it in your preferred online document editor.
2. Begin by filling out Section A, which requires your employee information. Input your member identification number, last name, first name, employer name, street address, city, state, primary phone number, and date of birth. Make sure to also include your ZIP code and any secondary phone number as needed. If you require additional claim forms, indicate your preferred method for receiving them by mail or email.
3. Proceed to Section B for dependent care information. Complete this section by providing the name of your dependent, the dates when care was provided, and the amount paid. Include the dependent care provider's name, address, tax ID number, and their signature. If the provider cannot sign, attach a written statement from them. Remember, dependent children must be under age 13 for reimbursement eligibility.
4. Move on to Section C for health care information. Attach any Explanation of Benefits (EOB) showing the amounts due for payment. If you lack an EOB, provide an explanation in the designated column and attach an itemized bill. Ensure you include no more than six receipts or EOBs with your submission. Remember, credit card receipts are not acceptable as itemized bills.
5. Finally, complete Section D, the claim certification. Review the claims list to ensure all required information is accurate and complete, then sign and date the form to certify the expenses incurred have not been reimbursed under any other plan. This step confirms your compliance with the request for reimbursement.
6. Once all sections are completed, save your document, and then you can download, print, or share the Uniaccount as needed. Make sure to keep a copy for your own records.

Take the next step and begin competing documents online today!