FSA

Tools

Your Account

Login to check your FSA, HRA or T&P account information.

COBRA Login

Login to check your COBRA account information.

 

Eligibility Login

Login to access your Enrollment and Eligibility account information.

Eligible Expense List

What expenses are eligible for reimbursement under a cafeteria/flex plan? Check your eligible expenses!

Tax Calculator

How much can you save in taxes by participating in cafeteria/flex and transit & parking plans? Check your tax savings! Enrollment is easy!

Online Claims

Entering your claim online is quick and convenient. Click here.

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Links to our PDF forms, documents, external resources and some help items are set to open in new browser windows. You may need to set your browser's pop-up blocker to accept pop-up windows for this site.

FSA Claim Forms


Click here to enter your claims directly into our system. Then simply fax the claim transmittal form and your supporting documentation to WageWorks, formerly Creative Benefits. Your claim will be reviewed in record time!

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FSA Spending Account Claim Form
Download a Spending Account claim form

DCSA Placeholder Claim Form
Download for use with Payment Card and Dependent Care Spending Account

Spending Account Claim Form Spanish version
Download a Spending Account claim form in Spanish

Alternate Insurance Premium Claim Form
Download an Alternate Insurance Premium Claim Form


Additional Claim Documentation

Letter of Medical Necessity
Download and take to licensed provider

Healthcare Dispute Form - VISA
To report credit card fraud

Receipt for Day Care Expenses
Download a receipt for your Day Care Expenses


How to Submit a Claim

3 Easy Steps to Submit a Claim
How to submit a claim form

Example Claim Form
Example of a completed claim form

3 Easy Steps to Submit a Claim Spanish version
How to submit a claim form in Spanish

Example Claim Form Spanish version
Example of a completed claim form in Spanish


Daily Claim Processing:

Claims received in our office before 2:00 P.M. Pacific Time will be processed by end of business day. You can verify the receipt and entry of your claims by accessing Your Account online or calling 1.888.295.5656 and following the prompts.

Claims received after 2:00 P.M. Pacific Time will be processed the next business day.


PDF Help

Having trouble downloading/opening a PDF file?

First: Set your browser to allow pop-up windows for this site.

Second: Update your Adobe Reader. Get the latest version available from Adobe (it's free).

Next: Try this work-around from Adobe to save the PDF file to your hard drive and open in Adobe Reader:

  1. Right-click the link to the PDF file and then choose Save Target As (Internet Explorer) or Save Link As (Netscape Navigator).
  2. In the Save As dialog box, select a location on the hard disk, and then click Save.
  3. Double-click the PDF file to open in Adobe Reader.

More Help: You can access the Adobe site here. Click on "Support" and then select "Help with the Free Adobe Reader Software."

 

Links

For Customer Service or questions about your account, contact us at: Email: Questions
Phone: 1.888.295.5656

Our Participant Support Specialists are available from 5:00 A.M. to 5:00 P.M. Pacific Time, Monday through Friday.

Claim Submission

Submit your completed and signed claim form with supporting documentation to:

Fax:
1.888.295.5757 or 1.888.452.5922

Email:
Claims

Mail:
WageWorks, formerly Creative Benefits
P.O. Box 1928
Vista, CA 92085-1928

Payment Cards

Using your Payment Card at merchants such as pharmacies, grocery and multi-use stores? Review the most up-to-date merchant list from SIGIS. Click here and then choose SIGIS Merchant List.