Healthcare Spending Account (HCSA) claim forms
Have coverage through your employer or plan sponsor? You’re in the right place.
If you have coverage through an advisor, use our personal insurance forms instead.
Start a paper claim
Use these forms to make a healthcare spending account (HCSA) claim. You'll find instructions for submitting each form on the form itself.
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If your plan includes a healthcare spending account, use this form to make a healthcare claim or get an estimate for healthcare expenses.
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If your plan includes a healthcare spending account, use this form to make a claim for dental expenses. You'll need the dentist to fill in some sections.