Claim Forms

Instructions and Tips for Claim Filing

• EE # — Employee Number — if applicable. Otherwise, leave blank.
  
  
• After typing in your information on the appropriate Interactive Claim Form, print, sign and send the information as spelled out in the "Three Ways to Submit your Claims" section below.
  
  
• When filing your Medical Expense Claim Form, you must attach copies of the receipts.
  
  The receipt must show the detailed statement of charges and the actual date of service or you may submit an Explanation of Benefit (EOB) from your insurance carrier.
  
  Canceled checks, credit card slips, cash register receipts, or statements, showing balance forward or balance due on your account are not acceptable.
  
  Prescription receipts must state names of provider, of the drug, of the doctor and the amount. Cash register receipts will not be accepted. You can place as many drug tags on one page as will fit or, you can check online with your pharmacy and print a “RX History”.
  
  If your Plan allows over-the-counter (OTC) medications, see the new Health Care Reform section on the Home Page. Containers and copies thereof are not accepted.
  
  A list of eligible medical expenses and acceptable OTC items is located within the Examples of Eligible Medical Care Expenses page. Check your Summary Plan Description to see if your Plan allows OTC expenses.
  
  
• When filing your Child/Elder Care Claim Form, you must either have the providers’ information on the bottom of the Form OR you must attach copies of the receipts that shows this information.
  
  
• When filing your Private/Outside Insurance Claim Form, you must attach “Proof of Coverage”. “Proof of Coverage” must be one of the following:
  
  
  1. A confirmation letter from the carrier stating the covered period and the amount.
     
     
  2. Submit your current invoice showing no prior balance is due for the prior period of coverage, or
     
     
  3. Your Bank Statement showing that the insurance carrier has drafted the payment from your bank account and the amount.

Three Ways to Submit your Claims:

1. Scan and email to claims@fbaflex.com
   
   
2. Mail claims with receipts to:
   Flex Benefit Administrators
   P.O. Box 800518
   Houston, TX 77280-0518
   
   
3. Fax to (713) 460-3550
   After you fax your claim and receipts one time, do not follow-up with a hard copy.
   


Please keep the original claim form and supporting documents for your records.
What is submitted to Flex Benefit Administrators will not be returned.

General Information

• The normal check minumum is $25.00. Claims will accumulate until minumum amount is reached. Minumun amounts will be reduced during the last 3 months of the Plan Year.
  
  
• To see your Flex Plan Calendar for claim due dates and check dates, log into your online account (instructions will be shown on screen) and choose “Tools”, then choose “Forms”.
  
  
• Please update your account information online. You can change your address, add
  your email address and add phone numbers. If your Plan allows direct deposit of
  your reimbursement, our system will email a notification of your payment (but only
  if you add it!).