Get FSAFEDS Health Care Claim Form
• Fax the same form more than once • Mail the same form that you have faxed • Include this instruction sheet with your fax Please DO: • Circle applicable items on your receipts (just don’t use a highlighter) • Use as many sheets for additional expenses as you need • Use code 999 for any eligible item that isn’t covered by one of the other Coverage Codes Questions? Need a list of eligible expenses? Go to www.FSAFEDS.com or contact an FSAFEDS Benefits Counselor at 1-877-FSAFEDS. .
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