What Form Should I Use?
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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
Spending Account Resources
Plan Limits and Mileage Rates
COBRA Frequently Asked Questions
Department of Labor's Site
Know Your Health Benefits Rights
What Form Should I Use
Submitting FSA Reimbursement Forms
Common Request Mistakes
First Time Online Spending Account Registration
Set Up Online Access
To set up an online account, you need two forms of identification:
Your Member ID.
Your Member ID is either your employee number or your SSN, whichever your employer has provided as your unique identification key in our system. If you aren’t sure which key is used for your account, you can either try both or email us at
Your Employer ID.
Your employer ID is provided in your Annual Welcome Email, on any automated claim correspondence, or on your Plan Highlights (available through your Benefits Department). If you don’t have any of these tools handy, you may use the Employer ID
Lookup option to your right or contact us at
Igoe Administrative Services