select What Form Should I Use? Download Forms ( Select Form ) ... FSA Reimbursement Request Dependent Care Reimbursement Request and Provider Receipt Commuter Cashback Request Form HRA Reimbursement Request Form Lifestyle Benefit Reimbursement Request Form Benefit Card Substantiation Coversheet Letter of Medical Necessity Template Orthodontia Treatment Statement Limited Purpose FSA Conversion Form Claim Appeal Form HIPAA Release Form

IMPORTANT INFORMATION REGARDING CLAIM DELAYS AND CARD DENIALS FOR PROGRAMS FUNDED BY AN EMPLOYER SPONSOR’S SILICON VALLEY BANK ACCOUNT (updated on 3/13/23): Due to the closure of Silicon Valley Bank (SVB), some benefit related activity has been suspended for partners who bank with SVB. If you are unable to enter a claim after experiencing a card denial and/or are unable to update any of your account information, that means that benefit activity has been temporarily suspended as your benefit Plan Sponsor banked with SVB and is working on securing access to their assets and/or a new banking relationship. Please send requests for reimbursement to [email protected] using the appropriate form accessible via the Download Forms section of our site. Our team will be pending these claims and will process them as soon as your benefit program is recalibrated with a new funding mechanism.

Spending Account Portal SIGN IN Registration Help?

INTRODUCING A SMARTER IGOE MOBILE APP If you have a Spending Account of any type with Igoe, we highly encourage you to download the free Igoe Mobile App available on the App Store or Google Play. Our newly improved Igoe Mobile App allows you to do the following: Submit claims and back up documentation Manage reimbursement preferences Use the medicine cabinet to manage prescriptions and find lower cost options Use a product sku tool to scan a product sku and determine eligibility prior to purchase and more To register on Igoe Mobile, please follow these registration instructions To view common Q/As, click here

Resources Videos, FAQs and More Forms Eligible Product List Dependent Care Expense List FSA Store HSA Welcome Kit Plan Limits and Mileage Rates COBRA Member Login Questions Call 800-633-8818 Option 1 Email [email protected] Hours: M – F, 8am – 5pm PT Did you know you can text us? Learn how

Need to replace your Benefit Card? Log on to your online account Click on or hover over the "Benefit Card" tab Select "Benefit Card Management" Click on the next to the card you are cancelling Request a new card in the replacement card window at the bottom of the screen. TIP: You may need to scroll down to see the replacement card window. Want to order an additional Benefit Card? Complete this form and email it to [email protected] Need Help? Here are guides for our top FAQs How to Submit Claims How to Register on the Igoe Participant Portal How to Reset your Igoe Participant Portal Password How to Register for Igoe Mobile How to Set Up Direct Deposit How to Order a Dependent Benefit Card Need an RX? If you want to submit a claim or substantiate a benefit card purchase for an item that requires a Letter of Medical Necessity or an RX, we’ve created this form that you can have your service provider complete. Receiving Plan Communications? Are you receiving communications from Igoe? Take a moment to review your communication preferences on your online account. You can sign up for a variety of email and text alerts ranging from monthly balance updates to plan year end spending and submittal deadline reminders. It’s also a good idea to add Igoe Administrative Services as a safe sender by approving the following two email addresses to your safe sender list: [email protected] and [email protected]. Want to Allow Account Access to Another Person? Your privacy is important to us (plus we have to abide by HIPAA). As a result, you will need to complete and submit this release form if you wish to have someone else access your account information with an Igoe Participant Services Representative.