PARTICIPANT
CLAIM FORMS

Please select the type of claim form you need:

HRA Health Reimbursement Arrangement (Funded with Employer Contributions) Health Care FSA Flexible Spending Arrangement (Funded with your Salary Redirections) Dependent Day Care FSA Flexible Spending Arrangement (Funded with your Salary Redirections)

Please review Admin America’s HIPAA Privacy Notice for Plan Participants

| Flex Plan Participants | HRAs | FSAs | COBRA |
| POP Plans |About Admin America | HIPAA Privacy Notice |
| New Cafeteria Plan Regulations | FSA Orientation Posters |
| COBRA Premium Subsidy Update |

Admin America, Alpharetta, GA
Phone: (770) 992-5959 or (800) 366-2961  e-mail: info@adminamerica.com