Claims

To better assist you, we have provided the following instructions when filing a claim:

Flexible Spending Account

To submit your FSA (Flexible Spending Account) claim, please open the FSA Claim Form and type directly into the PDF document. Once fully completed, please print the completed form and attach copies of your receipts. The receipt must show the date of service, type of service rendered and amount paid. Cancelled checks, credit card slips or statements showing only a balance due on your account will NOT be accepted. Please be sure to number each attached page (i.e.; Page 2 of 3, Page 3 of 3, etc.).

 (Please remember to keep a copy of the claim form and supporting documents for your records)

 If you choose to submit your FSA Claim Form via fax, please do not follow-up with a hard copy in the mail.

Attention: FSA Specialist
Fax: 818.456.5362

 If you choose to submit your FSA Claim Form via email, please send the email to:

Email: flex@pcfoy.com

 If you choose to submit your FSA Claim Form via the mail, please send the documentation to:

Peter C. Foy & Associates
21650 Oxnard Street, Suite 1900
Woodland Hills, CA 91367
Attention: FSA Specialist