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Questions about a claim? Please contact WageWorks at 877-924-3967.

Health Care Reimbursement Account Claim Form

Please use this form to request reimbursement for: eligible expenses not covered by any insurance plan, or the unpaid balance of a health, dental, or vision care claim submitted under an employees group plan.
 

Form Name	Format
Health Care Reimbursement Account Claim Form	PDF

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