Pacificsource Fsa

MyFlex: Online Claim Submission Instructions
MyFlex: Online Claim Submission Instructions This form is available from the Forms section of our website, PacificSource.com/psa. Allowed file types for receipts: MS Word (.doc), (FSA) and an HRA and are unsure which account to choose, you may refer to your Plan Information Sheet. ... Get Doc

CITY OF KLAMATH FALLS Flexible Spending Account January 1 ...
Flexible Spending Account . January 1, 2017– December 31, 2017 . What is it? • A Flexible Spending Account (FSA) is a tax-free employee funded account handled by PacificSource Administrators. ... Visit Document

CITY OF EUGENE Employee Benefits Handbook
At http://www.pacificsource.com/provider-networks.aspx or by contacting PacificSource. Submit claims using a City of Eugene FSA Claim Form or TRA Claim Form available on the Employee Benefits website. See the Flexible Spending Account and Transportation ... Retrieve Full Source

CITY OF EUGENE Employee Benefits Handbook
PacificSource Health Plans . Medical, Vision and Pharmacy Claims Administrator . www.pacificsource.com . Customer Service . Submit claims using a City of Eugene FSA Claim Form or TRA Claim Form available on the Employee Benefits website. ... Document Viewer

Central Oregon Community College
Central Oregon Community College Flexible Benefits Administration ENROLLMENT AUTHORIZATION AND AGREEMENT for 2014 -15 Instructions: Website: www.pacificsource.com/PSA EMPLOYER HR USE ONLY: Employee’s Effective Date of Coverage: Employee’s First Payroll Date: ... Read Content

EasyPay - Bethel School District
To participate in EasyPay, PacificSource must be your sole insurance plan, and you must only have one plan through PacificSource. Standard Flexible Spending Account (FSA) expenses that are listed under IRS Section 125 are eligible expenses. ... Access Doc

FLEXIBLE SPENDING ACCOUNT (FSA) CLAIM FORM
FLEXIBLE SPENDING ACCOUNT (FSA) CLAIM FORM Please complete the information on this form and review the following reminders: √ Is your Participant ID number included on the form? √ Is your Employer Name and FSA Group Number included on the form? ... Get Doc

Arnerich Massena, Inc. Health Reimbursement Arrangement (HRA)
Arnerich Massena, Inc. Health Reimbursement Arrangement (HRA) , Inc. has established this program to assist their employees in recovering their medical deductible costs under the PacificSource medical plan. FSA/HRA Claim Form, ... Read Document

SUMMARY PLAN DESCRIPTION Flexible Spending Account
HOME SCHOOL DISTRICT Flexible Spending Account Plan (the “Plan”) and the related Group Sponsored Insurance Plan, (TPA): PacificSource Administrators, Inc. P.O. Box 2797, Portland, OR 97208 Employer Representative or Named Fiduciary: SWEET HOME SCHOOL DISTRICT ... Read More

Benefits Open Enrollment Calendar Of Events 2015-16 Date Time ...
Benefits Open Enrollment Calendar of Events 2015-16 PacificSource FSA(4:00 – 4:15) Reliant Behavior Health (4:15-4:30) Benefits Fair (3:30 – 4:30) Health Team Healthy U HR Staff Vendors Thursday, ... Access Doc

Employee Benefit Enrollment Guide - Bethel School District
Page 12 Flexible Spending Account (FSA) Page 13 What Other Choices Do I Have? Page 14 – 20 All Eligible Employees PacificSource G0020201 888-977-9299 www.pacificsource.com Dental Plan ... Fetch This Document

Authorization To Disclose Protected Health P.O. Box 70168 ...
Authorization to Disclose Protected Health Information FSA or HRA Plan Claim transactions), I authorized (person/entity disclosing information) PacificSource Administrators, Inc. to use and disclose a copy of my ... Return Document

Flexible Spending Account (FSA) Claim Reimbursement Request Form
V09.08 Flexible Spending Account (FSA) Claim Reimbursement Request Form COMPANY INFORMATION (PLEASE PRINT) Company Name Division (if applicable) ... Retrieve Document

COLLEGE OF SOUTHERN IDAHO Flexible Spending Arrangement July ...
COLLEGE OF SOUTHERN IDAHO Flexible Spending Arrangement July 1, 2016 – June 30, 2017 What is it? A Flexible Spending Arrangement (FSA) is a tax-free employee funded account administered by o See our Benny Card flier available at www.pacificsource.com /psa for more details ... Doc Retrieval

STATE OF OREGON DEPARTMENT OF CONSUMER BUSINESS SERVICES ...
CONSUMER & BUSINESS SERVICES INSURANCE DIVISION INSURANCE DIVISION REPORT OF FINANCIAL EXAMINATION OF PACIFICSOURCE COMMUNITY HEALTH PLANS, INC. SPRINGFIELD, OREGON NAIC COMPANY CODE reimbursement administration including Flexible Spending Account (FSA) and Health Reimbursement ... Retrieve Content

SUMMARY PLAN DESCRIPTION Flexible Spending Account
SUMMARY PLAN DESCRIPTION Flexible Spending Account Effective: SCHOOL DISTRICT Flexible Spending Account Plan (the “Plan”) and the related Group PacificSource Administrators, Inc. P.O. Box 2797, Portland, OR 97208 Employer Representative or ... Doc Viewer

Benefits Contact Directory - City Of Springfield Oregon
PacificSource Administrators (FSA and HRA) Customer Service: (541) 485‐7488 Fax: (800) 575‐1109 Address: PO Box 70168 Springfield, OR 97475 Email: psa cust omer service@pacific urce. Website: http:/ /psa .pacifics ource c m Flex www .ybenn co ... Get Document

FAQ FOR 2015 SECTION 125 HEALTH CARE REIMBURSEMENT FOR ...
FAQ FOR 2015 SECTION 125 HEALTH CARE REIMBURSEMENT FOR ELIGIBLE MANAGEMENT EMPLOYEES When is Open Enrollment? Open enrollment for 2015 is October 21, 2014 PacificSource’s secure online system, “InTouch”. Onl y the employee needs to complete the Assessment in order to ... Fetch Here

Enrollment Form: Flexible Spending Account
Enrollment Form: Flexible Spending Account P.O. Box 70168 Springfield, OR (541) 485-8759 (800) 575-1109 PacificSource.com/PSA EMPLOYEE INFORMATION Employer name: Eugene School District 4J Effective date I understand that Health Care FSA amount above $500 remaining in ... Fetch Doc