| HOME | | | ABOUT AFA | | | CONTACT US | | | CAREERS | | | SITE MAP | | | LOGIN | | |
| Flex & Section 125 |
|
For additional reimbursement information visit the Frequently Asked Questions page or view the list of Common Expense Reimbursement Requests and Eligibility Guidelines.
| Reimbursement Forms |
 |
Forms displayed with this image are type-in forms.
Please complete and print the form, attach any additional documentation that may be required, and send to the address or fax number shown on the form. All documents are in Adobe PDF format. You will need the free Adobe® Reader® to view these documents. We recommend version 6.0 or newer. You can upgrade here. |
For The Educational Community:
FLEX: Flexible Spending Account Information Packet
|
||||
|
FLEX: Authorization for Automatic Deposits
|
||||
|
FLEX: Health FSA/Unreimbursed Medical Expense Reimbursement
Voucher
|
|||
|
FLEX: Dependent Day Care Expense Reimbursement Voucher/Provider
Acknowledgment Form
|
|||
FLEX: PHI Authorization Form
 |
||||
FLEX: Medical Travel Log
|
||||
For Business Employees:
|
FLEX: Flexible Spending Account Information Packet
|
||||
|
FLEX: Authorization for Automatic Deposits
|
||||
|
FLEX: Health FSA Expense Reimbursement Voucher
|
|||
|
FLEX: Dependent Day Care Expense Reimbursement
Voucher/Provider Acknowledgment
|
|||
HRA: Expense Reimbursement Voucher
|
||||
FLEX/HRA: Expense Reimbursement Voucher
|
||||
| Information for Section 125 Plan Administrators |
All documents are in Adobe PDF format. You will need the free Adobe® Reader® to view these documents. We recommend version 6.0 or newer. You can upgrade here.
For Educational Administrators: For Business Employers: * Password is required. Please contact your American Fidelity Representative for information
| TOP OF PAGE | PRIVACY POLICY | TERMS OF USE | LICENSING | RATINGS |