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WEBLast Updated: April 2024. Acclaris, Inc. is an affiliate of Willis Towers Watson which operates worldwide through subsidiary and affiliate companies. A list of the Willis …

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URL: https://viabenefitsaccounts.com/acclaim/index.html

Fidelity Retiree Health Reimbursement Plan

WEBYes. Employees who terminate from Fidelity, are at least age 55, and have 10 or more years of service are eligible to be reimbursed for eligible medical expenses incurred by …

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Note: Please see the reverse side of the form for eligibility

WEB(Rev 11/0 ) See reverse side for submission instructions 3.IM-H-470I.10 Special Health Assistance Provision (SHAP) Reimbursement Request Form Use this form to submit …

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These answers are based on general FSA rules

WEBOnly medical expenses that exceed 7.5% of your Adjusted Gross Income (AGI) can be deducted on your federal income tax return. Before-tax Health Care Flexible Spending …

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Via Benefits Login Help

WEBSign In Help. Enter your username to begin the sign in process if you have previously created a username and password. * Username - Enter your username. After entering …

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HEALTH CARE ELIGIBLE/INELIGIBLE EXPENSES

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These answers are based on general FSA rules

WEBOnly medical expenses that exceed 7.5% of your Adjusted Gross Income (AGI) can be deducted on your federal income tax return. Before-tax Health Care Flexible Spending …

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HEALTH CARE ACCOUNT- How to request reimbursement

WEBHEALTHCARE CLAIM FORM Fax to: 813-387-0744 Mail to: Accounts Customer Care, PO Box 25172, Lehigh Valley, PA 18002-5172

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Your HRA “Cheat Sheet”

WEBYour HRA “Cheat Sheet” What is a Health Reimbursement Account, or HRA? An HRA is an account 100% funded by your employer to be used for your eligible out-of-pocket …

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REQUESTING REIMBURSEMENT FROM YOUR HEALTH CARE …

WEBPage 1 – HEALTH CARE CLAIM FORM 3.GEC‐H‐469K.102 REQUESTING REIMBURSEMENT FROM YOUR HEALTH CARE ACCOUNT (Do not fax or mail this …

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HEALTH SAVINGS ACCOUNT (HSA) TRUSTEE-TO-TRUSTEE …

WEB1. Rollover: A Rollover is a cash distribution made payable to the account holder and may be redeposited with another custodian within 60 days. The account holder can either …

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IBM Reimbursement Request Form Health Care Spending …

WEBIf you have any questions about your account status, please contact us at www.acclarisonline.com virtually 24 hours a day, 7 days a week, or call the Acclaris …

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Via Benefits Login Help

WEBSign In Help. Enter your username to begin the sign in process if you have previously created a username and password. * Username - Enter your username. After entering …

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IBM Reimbursement Request Form Health Care Spending …

WEBAll information submitted with this form will be protected and maintained as required by law. If you have any questions about your account status, virtually 24 hours a day, 7 days a …

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Life Planning Account Reimbursement Request Form

WEBReimbursement services provided by Acclaris. Send completed forms to: Acclaris Reimbursement Center Inquiries: 1-888-880-2775, PO Box 25171 1-877-314-2240(TTY) …

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HEALTH SAVINGS ACCOUNT (HSA) DEPOSIT SLIP

WEBAcclaris, Inc. offers all account services and is the HSA custodian. Please cut along the dotted line. HEALTH SAVINGS ACCOUNT (HSA) DEPOSIT SLIP. HSA Account Holder …

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