EE # — Employee
Number — if applicable. Otherwise,
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
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
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.
Mail claims with receipts
Flex Benefit Administrators
P.O. Box 800518
Houston, TX 77280-0518
Fax to (713) 460-3550
After you fax your claim and receipts
one time, do not follow-up with a hard
Please keep the original
claim form and supporting documents
for your records.
What is submitted to Flex Benefit Administrators
will not be returned.
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
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
if you add it!).
The forms below
require Adobe Acrobat
Reader. If you do not have a PDF reader,
click on this icon to download one now.