Healthcare Reimbursement Accounts


Cafeteria Plans (Section 125 Plan)


FSA - Medical Expense Reimbursement

Use this form for your Medical Expenses, prescription Drugs, Dental and Vision Claims.

DCA - Dependent Care

Use this form for your Dependent Care Expenses.

OTC - Over the Counter Reimbursement

Use this form for your Over the Counter Medical Expenses. All Over the Counter Medications must have a prescription or letter of Medical Necessity.

ACH - Direct Deposit

Use this form if you want to have your claims directly deposited into your savings or checking account.

Disclosure Form

The disclosure form allows for a spouse or other person to have access to your Cafeteria Plan Account.

Health Reimbursement Arrangement(HRA)/Medical Reimbursement Plans (MRP)


MRP - Medical Reimbursement

Use this claim form for your Medical Reimbursement Account (MRP).

HRA - Medical Reimbursement

Use this claim form for your Health Reimbursement Account (HRA).

NCAT Medical Reimbursement


WBC Medical Reimbursement

ACH - Direct Deposit

Use this form if you want to have your claims directly deposited into your savings or checking account.

Disclosure Form

The disclosure form allows for a spouse or other person to have access to your reimbursement account.

Brochures


Know Your FSA/HRA Eligible & Ineligible Expenses!

 


Know Your Dependent Care Eligible & Ineligible Expenses!


 


To Access mybenny.com


 


Employee Welcome Letter to Benny Card

 


Claim Payment Procedures

 


Benny Card Facts

 


Things you should know about Payment at your office visit

 

 

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