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Healthcare Reimbursement

Download the Form

The HealthCare Reimbursement form is used when submitting for any medical services reimbursement from your Flexible Spending Account (FSA). The form should be printed, completed and submitted along with all corresponding receipts to EHIM’s Flexible Spending Department.

Attn: FSA Department

If you have any questions about how to complete the form please feel free to contact EHIM at 800-311-3446.