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Submit An Expense Or Claim

Submitting benefit expenses or claims is easy. Here’s what you need to know:

Medical Claims

In most cases when you receive medical care, you’ll be asked to present your insurance card at the time of service. This will enable your health care provider to determine what your plan covers and, typically, to submit a claim to your medical plan for you. In the event this doesn’t happen, or you feel you’ve been billed in error, contact your medical plan.

CIGNA Medical Claim Form [PDF]

Questions about CIGNA claims? Contact our Cigna Onsite representative.

Vision Claims

There are no claim forms to complete when you see a VSP provider. If you see an out-of-network provider, you can submit a claim for reimbursement [PDF].

Spending Account Claims

When you spend money for health care or dependent care expenses that are eligible for reimbursement from your Health Care Flexible Spending Account, Day Care Flexible Spending Account, or Limited Purpose Flexible Spending Account, the best thing to do is use your Spending Account Card to avoid having to submit receipts. When this isn’t possible, you must submit claims to ADP, our FSA administrator, using the appropriate form. (If you can’t find your card, contact WageWorks.)

Health Care FSA Reimbursement Form [PDF]
Day Care Reimbursement Form [PDF]
Limited Purpose FSA Claim Form [PDF] 

Health Savings Account

You can pay for care in any of four ways:

  1. Use your HSA debit card at the point of service.
  2. Set up Fidelity BillPay® for Health Savings Accounts, which allows you to make online payments. If your provider offers electronic billing, you can link them to Fidelity BillPay and receive an email notification when your bill is ready.
  3. The Fidelity HSA checkbook works just like the HSA debit card to pay at the point of service.
  4. Pay out of pocket and reimburse yourself later.

Kaiser members can reference this guide [PDF] for more information on paying for care and managing expenses.