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Reimbursement Accounts - Electronic Submission

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Important Submission Information HEALTHCARE CLAIMS New Claims must be submitted with a fully completed and signed Reimbursement Claim Form. NEED A HEALTHCARE FORM If you have received a Substantiation Letter or Denial Letter, please submit your receipt(s) and/or documentation with the letter you received from CBA Blue. DEPENDENT CARE CLAIMS New Claims must be submitted with a fully completed and signed Dependent Care Reimbursement Claim Form. NEED A DEPENDENT CARE FORM
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Please note: The uploaded file must be DOC, DOCX, PDF, GIF, JPG, PNG, TIFF or TIF in format. The uploaded file must be less than 28MB in size. Please note:Renaming a non-supported file type to supported file types will not be accepted. EXAMPLE: myfsareceipt.png to myfsareceipt.pdf Browsers supported: IE, Firefox, Mozilla, Netscape.