Take a look inside. These benefits are available to full time employees only. The Dependent Care FSA is used to reimburse you for certain expenses for children under age 13, or individuals unable to care for themselves. 0000010668 00000 n
_:1UDU Ordinarily, these expenses are paid with after-tax money. You can deposit funds in an HSA if: If you enroll in the HDP with an HSA, be sure to save receipts. . Your spending account is your checking account. Ohio Police & Fire Pension Fund. following: Questions regarding plan information for active/pre65: 214-556-0971. hZrG}} Ey{S6`
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952 salaries reported, updated at January 29, 2023. 0000032931 00000 n
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Y%l2r. Is this useful? Search CareerBuilder for Flexible Spending Account Plan Jobs in dallas,TX and browse our platform. LOCATION. Dependent Care FSA funds must be used by December 31, 2022, and all claims must be filed by March 31, 2023. Box 661147 Dallas , TX 75266-1147 Effective January 1, 2020, the paragraph Titled Agent for Services of Legal Process in the 0000021193 00000 n
70 56
Search Spending account jobs in Dallas, TX with company ratings & salaries. %%EOF
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Employees/Retirees can direct questions regarding benefits to the
Skip to Content Jobs Upload/Build Resume . You must be enrolled in a high-deductible health plan to participate. You are responsible for verifying your HSA was used for eligible medical expenses under the IRS tax code. 0000038345 00000 n
The benefits service center is available by phone and email to assist you with your benefit questions. 2023 Employees Retirement System of Texas. 0000021304 00000 n
All rights reserved. Dental Plan. See how we can help you reduce benefit costs, while delivering the best possible benefits experience. 0000050141 00000 n
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To enroll, you elect an amount to be deducted pre-tax from your paycheck over 24 pay periods and deposited into your FSA. hWn6wQd(eI%nWI3rq(Crn`f&bB(fbb l0\09NPL&1GA2ibt#RDK.V($;ER6``B?Cos[4#-`cng`d=ldKT-,l][`b]h|Y1&~W;F8K?8$MIL\/f`f,v[pjRI5[,fj The Medical Spending FSA, Limited Purpose FSA, and Dependent Care FSA are separate. 0000001416 00000 n
%PDF-1.3 Medical Spending/Limited Purpose reimbursement requests, as well as debit card transaction documentation, can be sent electronically, by fax, or by mail to HSA Bank. For new employees, these seed money contributions are available as soon as possible once your HDP becomes effective. 0
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Dependent care reimbursement for costs paid to day care and elder care providers. 4 0 obj
Learn about Dallas Independent School District Flexible Spending Account (FSA), including a description from the employer, and comments and ratings provided anonymously by current and former Dallas Independent School District employees. Health care reimbursement for qualified out-of-pocket health care expenses that are not covered by insurance (i.e. Eligible expenses include deductibles, coinsurance and prescriptions. 401 (k) Savings Plan. 2 0 obj
Argentina Australia Belgi (Nederlands) Belgique (Franais) Brasil Employee Assistance Program. Job Type All; Full-Time; Part-Time; Contractor; Contract to Hire; Intern; Seasonal / Temp; Gig-Work; Date Posted 24 hours . Dependent Care FSA is for dependent daycare only. 0000041523 00000 n
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Get Form Your Spending Account! Use professional pre-built templates to fill in and sign documents online faster. 2022 Medical, Dental, Vision and Prescription Active Employees. QFZ%us.7r?:7{7Zq u9s
Elevate your benefits and create more value for your customers. indicates you have dental insurance, proof HELPFUL HINTS If the receipt is handwritten, it must 0000328120 00000 n
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A Health Care FSA (HCFSA) is a pre-tax benefit account that's used to pay for eligible medical, dental, and vision care expenses that are not covered by your health care plan or elsewhere. hbbbd`b`` f
If the expense will be considered for insurance reimbursement, try to wait until you receive the Explanation of Benefits (EOB) from the insurance company to be sure that the debit card transaction is for the correct out-of-pocket amount. :Walgreens, Albertsons, Walmart) have IIAS capability. 0000037849 00000 n
The IRS also allows catch-up contributions of $1,000 if you are age 55 or older. This guide will help you get started with Your Spending Account (YSA) a website you can use to manage your retiree Health Reimbursement Account (HRA) whenever and wherever it's most convenient for you. A Flexible Spending Account (FSA) allows you to save money by using "before-tax" dollars to pay for certain health care and dependent care expenses. these need to be directed to hrbenefits@dallascityhall.com. hbbd``b`@H~7 1s=q_* RqYW$$cAb@D+A\/ H2e`bd =@a
For dependent care, you must submit the expense through www.hsabank.com or by mail. 108 0 obj
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No minimum balance fees. Spend it on your own terms. Your Spending Account is a trademark . /YRxFI. 1500 Marilla Street | 4FN | Dallas, TX 75201 Tel: 214-670-3659 Financial Transparency default- Financial Transparency Home Page 65 0 obj
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Your FSA funds may be used for qualified medical costs like copays and deductibles, prescriptions and some over-the-counter medicines, dependent care and more. 5y0eKL0A8+CN"Hs8vWb5x4\fG^xU"8Aj0'+jmh9C:ZL:P5#pD_W@`ain&b@$bu? Select the area where you want to insert your signature and then draw it in the popup window. No fees at TCCU ATM's. Spend your days in paradise or spend some love to a special someone. hbbd``b`q@ xsWF0+X D*@ !H N] !R D,X m7@D.P
$,Av$dAV prescription and office visit co-pays, lab fees, glasses, contacts, dental services, over-the-counter products, etc.). 0000005496 00000 n
%%EOF
The new address for YSA is: YSA will be sending official communication to members about the new address around during the first quarter of 2020. Disability Coverage. 3) After selecting "Documents and Forms" you will be directed to a screen that looks similar to the image below. 0000001858 00000 n
Withdrawals made for qualified expenses are also income tax-free. New claims forms will also be sent that include updated information. <>
You cannot transfer funds between accounts or charge multiple accounts for the same expenditure. Flexible Spending. by. h80%Em
w0a Records Building - 500 Elm Street, Suite 4100, Dallas, TX 75202. xYF+*FQvxJIa Find the extension in the Web Store and push, Click on the link to the document you want to design and select. The annual maximum contribution to a Dependent Care FSA is $5,000 (or. Members Report Fall Newsletter Now Available, OP&F Pre-Retirement Webinar video now available. 1) Register or log into your employer's Spending Account website. 0000050266 00000 n
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Representatives are available to assist you Monday through Friday, 7 a.m. to 7 p.m. CT and Saturday, 9 a.m. to 2 p.m. CT. 0000050063 00000 n
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=7XA2|{.X0i)i . There are three variants; a typed, drawn or uploaded signature. Seed money is not offered to those who add coverage in the high-deductible plan as a result of a mid-year qualifying event. You will have 90 days following your departure date to submit claims for expenses incurred before you left. Ordinarily, these expenses are paid with after-tax money. 0000003758 00000 n
414. Flexible Spending Accounts (FSA) for Medical Expenses and/or Dependent Care. &VkXHt9-@uO4,(+z(6 %%
Create an account using your email or sign in via Google or Facebook. If you have a Your Spending Account online, you will be able to: >E *8x)R}3ABlVeIoB~YC7=g=_SId8X UZKX %%EOF
Click here to view the 2023 Active Employee Benefitspresentation. Blade misrepresents OP&F. Glassdoor is your resource for information about the Flexible Spending Account (FSA) benefits at Dallas Independent School District. 0000002001 00000 n
Dallas County is joined with a cooperative insurance group along with other city and county agencies. The health care FSA lets you set aside money on a pre-tax basisfor both you and your eligible dependentsto pay for eligible health, dental and vision expenses. 0000021016 00000 n
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It is the second-most populous county in Texas and the ninth-most populous in the United States. 0000014230 00000 n
Apply to Administrative Assistant and more! 102 0 obj
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% Fax: 1-888-211-9900 Mail: Your Spending Account P.O. in dallas,TX. A TexFlexSM health care flexible spending account (FSA) is available to benefits-eligible employees not enrolled in Consumer Directed HealthSelectSM. plans offer two major different flexible spending accounts focused on medical and dependent care expenses. Contact Us | Help | Privacy Policy | ADA Statement. By law, any money left in your FSA(s) at the end of the year must be forfeited. ]A?~D-jF/aXdkut#F;u\#~,61'=mo/ di3{En. ,uFnPU5#kS_r,A'$$]3K ;>
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If you are not eligible for HSA contributions for example, if you are enrolled in Medicare the seed money contribution will go to an LP-FSA. endstream
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Details. When you enroll in the Medical Spending or Limited Purpose FSA, you will receive a debit card fromHSA Bank in the mail. The TexFlex health care FSA is administered by PayFlex Systems, Inc. To learn more about this FSA visit the TexFlex website or call TexFlex Customer Care toll-free at (866) 353 -9839 (TTY:711). Wb"77Su,1 U@k~l-[6rn20mn" =5ui{l;
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The Section 125 Flexible Spending Account plan is administered by United Health Care (UHC). 0000032172 00000 n
An HSA will be opened with Optum Bank for all newly enrolled HSA participants. Eligibility for the OP&F health care stipend: what to do when you have aQLE, Options available for retirement interviews, IRS using new versions of W-4P, W-4R for 2023 tax year, Member's Report Winter Newsletter Now Available. Austin, Texas 78701-2982. JOB DETAILS. Look through the document several times and make sure that all fields are completed with the correct information. POSTED. 0000021079 00000 n
to Your Spending Account by fax or mail: Fax: (888) 211-9900 Mail: Your Spending Account P.O. If you enroll in the HDP during annual enrollment, your employer will make a one-time cash deposit to your HSA in January. 0
You may also call 214-671-6947,Option 1. <>>>
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If you have elected to contribute to an HSA in 2022, you may also enroll in a Limited-Purpose FSA, even though both accounts may reimburse dental and vision expenses. in interesting facts about sam houston. Sending Your Claim to Your Spending Account Send this form and your documentation to Your Spending Account by fax or mail. You can also make pretax contributions to your HSA, up to IRS limits, to help your account grow. However, there is a grace period ending March 15, 2023to use your 2022Medical Spending FSA or Limited Purpose FSA dollars on eligible expenses. The plan helps you save money for health care and dependent care expenses. If your account balance is $2,000 or more, you can choose to invest funds look for details in your Welcome Kit. Share on Facebook . New claims forms will also be sent that include updated information. Box 661147 Dallas, TX 75266-1147 If faxing, be sure to place this form before your receipts and don't include a cover letter. As of the 2010 census, the population was 2,368,139. HlN1E+c'N^-TV3h/:L8cy x]Ks7Ja{ S1T)(eY,':{PllMn`( h/[(hO;Vh]J(QKSVZW>Tztrp|Xo=ATteUGGyYvwx^.-nw)jfYY]s|36tQLi86lNiO77opzv~c*Tf6vZKjx=xC.-uiSJ[jl-
6ZVA>>q&jP6b}iR4iHd(Cpu\e_'? If the merchant does not accept the card, submit the expense through the HSA Bank website (www.hsabank.com) or by mail. KY"X_Th[[TEe-wW This is the place to take action with Your Spending Account. Search for the document you need to design on your device and upload it. hb```V\af`0pHN@9(PsH 6s+s{}p=-z{FwYn^ (4hh@3V iq -tl2J870dNl`g*aQw\4uy4? Your Medical Spending FSA may be used to reimburse out-of-pocket medical expenses for you, your spouse, and your dependents. Funds are available three business days after payroll deduction. Legal Information | Privacy Statement | About this Site 2023 Alight Solutions plc View all FAQs Savings Calculators It will NOT hold Dependent Care funds. stream
Make a difference with your change - lead with ingenuity! Install the signNow application on your iOS device. 0000029844 00000 n
Your Spending Account jobs Sort by: relevance - date 271,102 jobs Fast hiring You'll evaluate vendors and issue purchase orders for goods and services, while relying on your experience, training, and judgment to plan and accomplish goals. The average salary for a account manager is $66,200 per year in Dallas, TX and $12,000 commission per year. As long as you maintain an account balance of $500 or more, you will not be charged the $1 monthly account maintenance fee. Get access to thousands of forms. You may be required to submit documentation of your expenditures. 4 0 obj Toll-free: (877) 275-4377 Records Building - 500 Elm Street, Suite 4100, Dallas, TX 75202 Phone: (214) 653-7638 Fax: (214) 653-7608 The out-of-pocket medical and dependent care expenses that you pay each year can quickly add up to hundreds, or even thousands, of dollars. 2023. Health Spending Accounts. You are not covered by another medical plan (unless it is an HDP) or a general-purpose FSA. And free to you. 0
:~va*$# R1M{D=AY[7A[-]#k HELPFUL INTS If the receipt is handwritten, it must include the service provider's signature. Ordinarily, these expenses are paid with after-tax money. . Open the email you received with the documents that need signing. endobj
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UT FLEX How to Use Your Flexible Spending Account. Spending Account Claim Form TOLL FREE: 888.868.FLEX (3539) myameriflex.com uYou can submit this data via myameriflex. The TexFlex health care FSA is administered by PayFlex Systems, Inc. To learn more about this FSA visit the TexFlex website or call TexFlex Customer Care toll-free at (866)353-9839 (TTY:711). .`9\Bs(|+p*l8=+)n'W=rj94
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Your flexible spending account (FSA) balance is yours to spend through December 31st of each year. Questions regarding Medicare Advantage Plan (MAPD): 877-299-1008. stream 7,514 Flexible Spending Account jobs available in Dallas, TX on Indeed.com. . All Rights Reserved. Box 661147 Dallas, TX 75266-1147 If faxing, be sure to place the form before your itemized receipts and don't include a cover letter. You cannot be claimed as a dependent on someone elses tax return. 0000050880 00000 n
No monthly maintenance fees. xH&c$CNRKW3suU/gz_?];7}>xrkUeh]~e6kPU+Wqv88[w]=wg]]^~pQU:HK)\xwv};Co]qo_ h`3V}s"_G02(JH(gS^mHF*J6ic$QhneP_28|( 9RNRMU&iL\Tk+#zwV" All rights reserved. Add the PDF you want to work with using your camera or cloud storage by clicking on the. That insurance company is PEBC (Public Employee Benefits Cooperative). endstream
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Responsible Office(s) Employee Benefits. Then, you may request reimbursement from the account when eligible expenses are incurred. "b!bULZX |fX3X6{. endstream
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Unlike an FSA, there is no use it or lose it rule and it comes with triple-tax benefits: For 2023, you can contribute $3,850 through payroll deduction if you have individual coverage or $7,750 if you have family coverage. All claims must be submitted by March 31, 2023. endstream
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Posted 6 days ago Machine Operator Positions Futamura 3.2 Topeka, KS From $30 an hour Full-time Day shift + 2 endstream
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Keep your receipts and invoices. Flexible Spending Accounts. Additionally, any claim forms, communications or notices generated by YSA since the change have included the new address. to Your Spending Account by fax or mail: Fax: (888) 211-9900 Mail: Your Spending Account P.O. Here's what you'll learn: d How to access your account This is an IRS rule. The PEBC HDP is an HSA-eligible plan. Traditional Health are Flexible Spending Account*); Visit www.hsabank.com for a list of eligible expenses and to set up direct deposit for expense reimbursement. 0000032520 00000 n
<< /Length 5 0 R /Filter /FlateDecode >> Apply to Customer Service Representative, Procurement Manager, Account Executive and more! Smart-Choice The Woodlands, TX 77387 Health Savings Account administration Smart-Choice Accounts PO Box 64009 -4009 Human Resources Centre (HRC): 1-888-927-7700 BMO U.S. Benefits Enrolling and making changes to your annual . Select the document you want to sign and click. 2.3k. FLEXIBLE SPENDING ACCOUNTS (FSA) The Flexible Spending Accounts (FSAs) allow you to pay for eligible healthcare and dependent care expenses using tax-free dollars - money taken out of your paycheck before income or Social Security taxes have been calculated. 0000050534 00000 n
Jj>`avp 78L` Apply now for jobs that are hiring near you. %PDF-1.5
%
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Short term detention pending investigation as a consequence wisconsin form, How Do I Sign Vermont Finance & Tax Accounting Document, Help Me With Sign Vermont Finance & Tax Accounting Document, How Can I Sign Vermont Finance & Tax Accounting Document, Can I Sign Vermont Finance & Tax Accounting Document, How To Sign Vermont Finance & Tax Accounting Document. The maximum annual Medical Spending FSA election is $2,750. The address for Your Spending Account (YSA), who handles the health care stipend reimbursements for OP&F retirees, has changed. to Your Spending Account by fax or mail: Fax: (888) 211-9900 Mail: Your Spending Account P.O. The entire annual amount you elect may be used at any time during the plan year and is available January 1. If youre are enrolled in Consumer Directed HealthSelect and are interested in setting aside money on a pre-tax basis for eligible dental and vision expenses, check out the TexFlex limited-purpose FSA. Dallas, TX 75234 1 972-243-6191 ClubCorp on facebook; ClubCorp on instagram . This is called the "use it or lose it" rule. To enroll, you elect an amount to be deducted pre-tax from your paycheck over 24 pay periods and deposited into your FSA. Unlike Medical Spending FSAs and Limited- Purpose FSAs, Dependent Care FSAs may only reimburse expenses up to the amount you have contributed to date. The average salary for a account executive is $74,443 per year in Dallas, TX and $20,000 commission per year. Generally, large pharmacies, grocery stores, and box stores (i.e. Which plans are eligible for the OP&F stipend? The grace period does not apply, and you may not roll these funds into a Limited Purpose FSA for 2022. HVnF|Wt8V`Hv^{PXfLOuuP@^,rOnEC'/\R@gg//hy<8 lN~N 0$xXOR~uJV:5y~DR
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FG U%KPc4WJ+ If you have specific questions about your benefits, please contact the Human Resources Department at(214) 653-6579or(214) 653-6161. 0000000016 00000 n
When you elect this benefit, you will enjoy a tax savings because the money for these items is deducted before taxes. :g5]0h>*4^"m$Ma}Y_n"a5Bz9ZKCN+1]UWTg^YzClC:wF2v sgT3jhxK.r1vt;;m>.#|cw[ZPj}:{+r&pCsaZzL)[_}P? Glassdoor is your resource for information about the Flexible Spending Account (FSA) benefits at AT&T. Learn about AT&T Flexible Spending Account (FSA), including a description from the employer, and comments and ratings provided anonymously by current and former AT&T employees. 1 0 obj
Once your account is opened, you will receive a Welcome Kit in the mail. 5 days ago. Legal Information | Privacy Statement | About this Site 2023 Alight Solutions plc
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Benefits Service Center1500 Marilla StreetRoom 1D-SouthDallas, Texas 75201Phone: 214-671-6947, Option 1Fax: 214-659-7098. With an HCFSA, you use pre-tax dollars to pay for qualified out-of-pocket health care expenses. your spending account (ysa) login your spending account hewitt ysa reimbursement phone number your spending account phone number at&t hra claim form Create this form in 5 minutes! Build loyalty and strengthen relationships with a powerful lineup of industry-leading benefits solutions. Contact Optum Bank for details. Your Spending Account P.O. Benefits of Using YourSpendingAccount. Real Est, Argonne Retirees | Argonne National Laboratory, A health reimbursement account (HRA) will be established to help reimburse you for the BlueCross BlueShield of Illinois claim form or International claim form. HELPFUL HINTS If the receipt is handwritten, it must include the service provider's signature. The card will hold Medical Spending and/or Limited-Purpose funds. %
Deep integrations streamline the experience at every step. 2a`bd r.#L^
8,033 open jobs for Spending accounts in Dallas. VIEWS. This is the place to take action with Your Spending Account. Note: If you currently participate in the Medical Spending FSA and elect the HSA medical plan for 2022, your FSA funds will expire on December 31, 2021. After that, funds in excess of $570 will be lost so be sure to use them while you can. Questions regarding Medicare Advantage Plan (MAPD): 877-299-1008 All other questions that cannot be answered by either of these need to be directed to hrbenefits@dallascityhall.com. endobj
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After submission, you will be asked which method of reimbursement you prefer (electronic transfer, check, etc.). (512) 499-4200. Its county seat is Dallas, which is also the third-largest city in Texas and the ninth-largest city in the United States. Prescription Drugs Plan. %PDF-1.4
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Fax: (512) 867-7438. endstream
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1.8k salaries reported, updated at February 15, 2023. Paid Family Leave. <>
The entire annual amount you elect may be used at any time during the plan year and is available January 1. Flexible Spending Accounts. 0000029729 00000 n
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Pension Plans. Questions regarding plan information for active/pre65: 214-556-0971. Read our response. 0000020691 00000 n
An HSA is a savings account that you can use to help cover qualified health care expenses. You may also call 214-671-6947, Option 1. Representatives are available to assist you Monday through Friday, 7 a.m. to 7 p.m. CT and Saturday, 9 a.m. to 2 p.m. CT. <<345A0DA70B0308418CEB8C1CDDA1C003>]/Prev 332151/XRefStm 1690>>
Records Building - 500 Elm Street, Suite 4100, Dallas, TX 75202Phone: (214) 653-7638 Fax: (214) 653-7608. You cannot submit claims for services received after your departure date. But first, you must participate in at least one account in order to have access to YourSpendingAccount. Life and Accident Plans. Old Red Museum of Dallas County History and Culture, Community Supervision and Corrections (Adult Probation), Department of Unincorporated Area Services, Office of Homeland Security and Emergency Management, Dallas County Unincorporated Area Strategy, Vehicle Registration - VTR 68-A Inspections, Dallas Area Rapid Transit (DART) Pass Program, Colonial Life Voluntary Supplemental Insurance, Public Employees Benefits Cooperative (PEBC). Document Type. xref
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Start completing the fillable fields and carefully type in required information. You are covered under an eligible high-deductible plan (like the HDP). Draw your signature or initials, place it in the corresponding field and save the changes. The out-of-pocket medical and dependent care expenses that you pay each year can quickly add up to hundreds, or even thousands, of dollars. HTK \* cJe17ioL}[8j ('96&|2"O+"q3vc$0n$v{&[zkT[R3jd3IC%I+I6;zN>*OfqQm~8M(0gngV>S(P4P Posted 11/22/2019 Other News Local: (614) 228-2975 Customer Service: 1-888-864-8363 Fax: (614) 628-1777 2) Select "Documents and Forms" from the left-hand navigation menu. your spending account dallas, tx. It will help you learn more about your accounts and the reimbursement process involved with your financial activities. kiL/o0[~A(V-+>%ieoUaooeyl \ 0000008111 00000 n
Your Spending Account P.O. Dallas County offers Flexible Spending Accounts (FSA) that allows you to use pretax salary dollars to pay for these expenses often at significant savings for your family. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
Create your signature, and apply it to the page. 0000002974 00000 n
Box 64030 The Woodlands, TX 77387-4030 If faxing, be sure to place this form before your receipts and don't include a cover letter. 447 Flex Spending Account jobs available in Dallas, TX on Indeed.com. hb``0a``K0D800 @1CKxGC/C` |FE_,sUl/001 *^#v F )" ,/+Y2Pu Go to the Chrome Web Store and add the signNow extension to your browser. UT Dallas; UT El Paso; UT Permian Basin; UT Rio Grande Valley; UT San Antonio; UT Tyler; Health Institutions. 0000003548 00000 n
It comes complete with a debit card. Your Spending Accounts PO Box 661147 Dallas, TX 75266-1147 YSA will be sending official communication to members about the new address around during the first quarter of 2020. }@2D8inx%'\#d;aT n$M4IAWDHl|"I@*x/#28}}?Qoe?IU6b3hM v':H,! Retirement Plan with Employer Match . All other questions that cannot be answered by either of
The out-of-pocket medical and dependent care expenses that you pay each year can quickly add up to hundreds, or even thousands, of dollars. It's free to use. Is this useful? Decide on what kind of signature to create. Download your copy, save it to the cloud, print it, or share it right from the editor. Dallas County is a county located in the U.S. state of Texas. O;T
Phone: (214) 653-7638 Fax: (214) 653-7608. 0000014112 00000 n
A Flexible Spending Account (FSA) allows you to save money by using "before-tax" dollars to pay for certain health care and dependent care expenses. To comply with HSA rules, your Limited- Purpose FSA may only be used to reimburse out-of-pocket dental and vision expenses for you, your spouse, and your dependents. Box 64030 The Woodlands, TX 77387-4030 If faxing, be sure to place this form before your receipts and don't include a cover letter. 7R=nq(C(k[B%xpi
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This benefit allows you to deduct money from your paychecks for: For additional information, please visit the Public Employees Benefits Cooperative (PEBC)website atwww.pebcinfo.com. According to Aon and YSA, any mail received at the old address is automatically forwarded to the new address. Dallas, TX. Vision Plan. Select the area you want to sign and click. Benefits Service Center1500 Marilla StreetRoom 1D-SouthDallas, Texas 75201Phone: 214-671-6947,Option 1Fax: 214-659-7098. Box 661147 Dallas, TX 75266-1147 Tel: (888) 611-5500 (toll free) Monday through Friday: 8 a.m. - 6 p.m. CT . 0000009380 00000 n
Employer Name: Employee Name: SSN: Phone: Email: Medical Expense Claims (FSA, or Employer funded HRA) Dependent Day Care Claims Account Type FSA HRA Date Expense Incurred Name of Person Receiving Medical Service Provider Name
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