Health Care Reimbursement Account:

• Submit bill to medical, dental, or vision insurance carrier (unless SecureOne is also providing the administration for these services).
• When Explanation of Benefits Statement is received from carrier, submit this, along with a completed FSA Claim Form (49KB PDF) to SecureOne Benefit Administrators, Inc. for reimbursement.*
• Be sure claim is received in our office (3) business days prior to the scheduled date for claims processing for your company to insure that it will be included with that date's check run.

*In most circumstances, the Explanation of Benefits Statement from your insurance carrier is considered valid proof; however, there may be other times that we will need a copy of the itemized statement as well, showing what the expense is.

Dependent Care Reimbursement Account:

• Complete FSA Claim Form (49KB PDF)
• Submit claim form with valid proof of dependent care expenses (cancelled check, receipt) showing dates of service, as well as the cost for the dependent care.
• Be sure claim is received in our office (3) business days prior to the scheduled date for claims processing for your company.
• We do not need your day care provider's Social Security or Tax ID Number.

If you have a claim that you are uncertain how to submit, please feel free to call our office.
Thank you for your cooperation.

	Submit claims to:
	SecureOne Benefit Administrators, Inc P.O. Box 1744 Grand Rapids, MI 49501 (616) 454-4000 or 1-800-876-7475 FAX (616)-454-4338