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206-281-1580
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1-800-426-5980
ext. 471580

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206-285-4789
Toll-free
1-800-426-5980
ext. 471580

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When filing your claim, you must attach copies of the receipts. The receipt must include the service provider's name and the date and type of service for each expense. Canceled checks, credit card slips, or statements of balance due are not acceptable.

If you fax your claim forms and receipts, please do not follow up with hardcopy.

Always retain a copy of all forms and receipts. You may make copies of the blank form for your future use.

	Flexible Spending Account / Unreimbursed Medical Account Reimbursement Claim Form (pdf)
	Flexible Spending Account / Dependent Care Account Reimbursement Claim Form (pdf)
	Northshore School District #417 CEA Reimbursement Form (pdf)