UCAR Finance & Administration

Forms Library


Form Details...

Form Title: WageWorks Health Care Flexible Spending Account Claim Form
Last Revised: 1/2009
Purpose: Allows reimbursements from the WageWorks Health Care Flexible Spending Account. Plan effective 1/1/09.
Who Should Use the Form: Employees contributing to Health Care Flexible Spending
Instructions:

Employee completes the form and signs.  Mail to: Claims Administrator, PO Box 14053, Lexington, KY 40512, OR fax toll-free to: 1-877-353-9236 (no cover page is required)

View/Fill Out the Form: Click here to view and/or use the form in .pdf format
Problems? Contact: Irena Haimsky, x8706

If you are having trouble downloading forms see HELP below.


Search Help F&A Home

Questions or Comments? Contact the F&A Webmaster at:
webmaster@fanda.ucar.edu


Thank you!