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Paper Reimbursement Claims
You can download and print the claim forms needed to request reimbursement from your Health Care and Dependent Spending Accounts via My Health or on your carrier's website (Aetna/PayFlex or Cigna).
Please Note: The Dependent Care Spending Account requires that your receipt include the care provider's name, address and taxpayer identification number (or Social Security number). Without this information, the care usually won't qualify as an eligible Dependent Care Spending Account expense.
Send your completed claim form and supporting receipts to the appropriate address or fax number:
Claim Form
For Health Care and MRA Claims
P.O. Box 14079
Lexington, KY 40512-4079
Phone: (800) 468-1266
Monday through Friday, 8 a.m. to 8 p.m., Eastern time
For Spending Account Claims (Health Care and Dependent Care)
Payflex Systems USA, Inc.
P.O. Box 14879
Lexington, KY 40512-4879
Fax: (888) 238-3539
(888) 678-8242
Monday through Friday, 8 a.m. to 8 p.m., Eastern time
P.O. Box 182223
Chattanooga, TN 37422-7223
Fax: (859) 410-2432
Toll-Free Fax: (877) 823-8953
You must submit claims incurred during the plan year (January 1 – December 31) by the claim filing deadline, March 31 of the year following the plan year. If you are submitting your claim by mail, the postmark date must be no later than March 31.