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Updated MedBen Specialty Services Forms Available on MedBen.com

04/14/10

  09:27:06 am, by MedBen5   , 254 words,  
Categories: Announcements, Health Plan Management

Updated MedBen Specialty Services Forms Available on MedBen.com

If MedBen administers your group’s flexible spending accounts (FSAs) or transportation compensation accounts, please note that several of the forms used to participate in the plans and request reimbursement have been recently updated. The revised documents are available for download on the MedBen Specialty Services Forms page at MedBen.com.

Updated MedBen forms include the following:

FSA FORMS

FORM 1100 and FORM 1100b: FSA Compensation Redirection Agreement
There are now two versions of this employee enrollment form, replacing the prior single version. If your company does not offer the option of an FSA debit card, use Form 1100. If it does offer a debit card, use Form 1100b.

FORM 1102: Dependent Care Spending Reimbursement Request Form
Use this form to request reimbursement from the Dependent Care spending account of your MedBen FSA.

FORM 1103: Dependent Care Receipt for Services Form
A caregiver or provider of service can use this form as a receipt for dependent care services provided.

FORM 1105b: Debit Card Substantiation Form
Use this form to substantiate purchases made with your MedBen “Benny” Debit Card.

FORM 1107: Health Care Spending Reimbursement Request Form
Use this form to request reimbursement from your Health FSA account.

FORM 1109: Orthodontia Services Reimbursement Request Form
An orthodontist (or authorized bookkeeper) can use this form to request reimbursement for services.

TRANSPORTATION COMPENSATION FORMS

FORM 1116a: Transportation Compensation Redirection Agreement
Use this form to participate in your company’s transportation compensation plan.

If you have questions regarding the use of these or any MedBen Specialty Services forms, please call Specialty Services Customer Service at (800) 297-1829.

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