Dependent Care Reimbursement Account Claim Form
Please use this form to request reimbursement for dependent day care expenses.
Questions about a claim? Please contact HealthEquity at 877-924-3967.
| Form Name | Format |
|---|---|
| Dependent Care Reimbursement Account Claim Form (can be filled in electronically) |
Categories
Benefits - Dependent Care Reimbursement Account, Benefits - Reimbursement Accounts