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Flexible Spending Arrangement Claims

Company code for claim forms is: PCY

FSA Claim Form 

2015 Plan Year

Reimbursement Account Expense Dates Claim Deadlines
Health Care Jan. 1 2015 - March 15, 2016 April 30, 2016
Day Care Jan. 1 2015 - March 15, 2016 April 30, 2016

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