WageWorks – FSA

As of January 1, 2004, WageWorks has replaced the EBPA Flexible Spending program. Please use your WageWorks debit card to pay for expenses (this is the preferred method) OR visit their Web site for reimbursement forms and instructions. Reimbursement forms may also be obtained by calling the number below.

Provider Information for submitting claims:

WageWorks Processing Center
4129 E. Van Buren St., Suite 220A
Phoenix, AZ 85008
Fax: (610) 263-0027

Ph: (877) 924-3967
Web site: www.wageworks.com

Forms:

Health Care Pay Me Back Claim Form (PDF)

Dependent Care Pay Me Back Claim Form (PDF)

USNH Flexible Benefits Policy