Health Care FSA Claim Instructions

Log in to - If you haven’t registered on, you’ll need to enter your name, date of birth and member ID from your health plan ID card or your Social Security number.

1. From your home screen, click on Manage your Flexible Spending Account (FSA) to access the Claims and Accounts screen.

2. Select Submit a Claim from the blue bar at the top of the Claims and Accounts screen.

3. Select the FSA Health Care Claims Online Submission button to pop up a new online claims form page.

4. Complete the online form, submit and receive your confirmation.

For members that wish to mail their form in, please have them follow these instructions:

To submit by mail:

1. Visit without logging in.

2. Scroll down to Popular Forms, click the button and follow navigation to the Flexible Spending Account Request for Dependent Care Reimbursement form.

3. Print, complete and mail or fax to:

Health Care Account Services Center
P.O. Box 740378
Atlanta, GA 30374
Fax: 1-248-733-6148