C.H. Reams & Associates, Inc.
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  • Our Team
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  • FSA Resources
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    • About
    • Our Team
    • Services
    • HR & Compliance
    • FSA Resources
    • COBRA
    • MEDICARE
    • Forms
    • Contact Us
C.H. Reams & Associates, Inc.
  • About
  • Our Team
  • Services
  • HR & Compliance
  • FSA Resources
  • COBRA
  • MEDICARE
  • Forms
  • Contact Us

HRA Carrier Claim Forms

Deductible Reimbursement (HRA) Claim Forms (carrier specific)

HIGHMARK - HRA Claim Form (pdf)

Download

UHC - HRA Claim Form (pdf)

Download

UPMC - HRA Claim Form (pdf)

Download

CHR Flexible Spending Account (FSA) Claim Form

Flexible Spending Account (FSA) Reimbursement Claim Form (Medical and/or Dependent Care)

Summit FSA Claim Form (pdf)

Download

FSA Eligible & Ineligible List

Eligible or Ineligible Expenses under Medical FSA or HSA plans (not all inclusive)

Eligible-Ineligible Listing (pdf)

Download

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