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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.
Simplifying the complexity of benefits for maximum savings and peace of mind.
245 Kenneth Drive
Rochester NY 14623-4277
EMPLOYEES: (800) 473-9595
EMPLOYERS: (866) 996-5200
The Beniversal and eTRAC Prepaid Mastercards are issued by The Bancorp Bank, N.A., Member FDIC, pursuant to a license by Mastercard International Incorporated and may be used everywhere Mastercard is accepted. Mastercard is a registered trademark, and the circle’s design is a trademark of Mastercard International Incorporated.
HSA Custodial Services are provided by a separate financial institution. See your HSA Account Agreement for specific account terms.
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