File a Reimbursement Claim

FSA

Fill and Print Claim Form	Print a Blank Claim Form

Complete the form and submit to ProBenefits along with appropriate documentation.
Learn more about filing FSA Reimbursement Claims.

HRA/MERP

Fill and Print HRA/MERP Claim Form	Print a Blank HRA/MERP Claim Form

Complete the form and submit to ProBenefits along with appropriate documentation (in most cases, an insurance Explanation of Benefits, or EOB, is required).