C.H. Reams & Associates, Inc.
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    • CHR HOME PAGE
    • The CHR Family
    • Insurance
    • HR & Compliance
    • FSA Resources
    • Forms
    • Contact Us
C.H. Reams & Associates, Inc.
  • CHR HOME PAGE
  • The CHR Family
  • Insurance
  • HR & Compliance
  • FSA Resources
  • 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)

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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)

FSA Claim Form MED+DCAP (pdf)

Download

FSA Eligible & Ineligible List

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

Eligible-Ineligible_Jan 2022 (pdf)

Download

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