Claims

Flexible Spending Arrangement Claims



Company code for claim forms is: PCY

FSA Claim Form

2015 Plan Year

Reimbursement Account Expense Dates Claim Deadlines
Health Care Jan. 1 2015 - March 15, 2016 April 30, 2016
Day Care Jan. 1 2015 - March 15, 2016 April 30, 2016

2016 Plan Year

Reimbursement Account Expense Dates Claim Deadlines
Health Care Jan. 1 2016 - March 15, 2017 April 30, 2017
Day Care Jan. 1 2016 - March 15, 2017 April 30, 2017