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Extensive list of IRC section 125 eligible expenses to help you plan your Medical FSA election.
To enroll in your FSA Plan or to report changes in status, address, elections, etc.
For your dependent care provider to use as a receipt for eligible dependent care services provided to you.
Extensive list of IRC section 125 eligible expenses to help you plan your Dependent Care FSA election.
To provide supporting documentation when claiming mileage for eligible services from your pre-tax account.
To set up new authorization of reimbursements to be deposited directly into your bank account or to change current direct deposit information.
To use for medical services/items that require additional documentation from a licensed health care provider.
Sample chart of OTC items that may be eligible from your HSA.
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HSA Custodial Services are provided by a separate financial institution. See your HSA Account Agreement for specific account terms.
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