Form

Description

If you are updating your Flex contributes for COVID-19 reasons, use this form and submit to HR.

Click HERE for full COVID-19 Flex change information

Username and password for the Flex App are different than your pbaclaims.com account.

This form details many items that are eligible to be taken from the FSA and contains a worksheet to help determine how much to withhold.

Fsafeds.com lets you search FSA eligibility and lists if items need additional documentation to be eligible. Click here for link directly to FSA eligible expenses search.

Additional Resource:

FSAstore.com is an online marketplace for FSA-eligible products.

This illustration will help you determine whether or not to use the direct deposit feature on your FSA account.

Complete this form to submit claims for unreimbursed medical/dental and dependent care expenses from your flexible spending account.

 

 

Certain items may be considered eligible expenses if deemed Medically Necessary by a prescribing physician. Have your provider completed this form. 

 

You can also submit claims online at www.pbaclaims.com or on the PBA Flex App. This is the recommended and fastest way to submit claims for reimbursement.

Use the Flex Election Form to verify where you would like your Think Healthy contribution to go. Flex Spending or Deferred Compensation. 

Flex Plan Documents effective 2013 until changed

Information on how to access your PBA  account

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