Claims

Flexible Spending Arrangement Claims



Company code for claim forms is: PCY

FSA Claim Form

2017 Plan Year

Reimbursement Account Expense Dates Claim Deadlines
Health Care Jan. 1 2017 - March 15, 2018 April 30, 2018
Day Care Jan. 1 2017 - March 15, 2018 April 30, 2018

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