Flexible Spending Account Claim Form

The information provided herein only represents a summary of plan features that may be available. Since health insurance plans and rates may vary, please consult the plan documents for the most descriptive and current information. Certain exclusions and limitations may apply. The examples and figures provided herein are for illustrative purposes only. The Company reserves the right to amend the benefits provided to employees at any time at its discretion to the extent permitted by law. The Company does not provide tax or investment advice. The information provided herein does not create a contract of employment.