This form is to be completed by your provider after dependent care expenses have been incurred and should be used in place of dependent care documentation.

This form is to be completed each plan year and as changes occur when you want to receive recurring reimbursement of dependent care expenses. 

Submit a claim on your Chard Snyder online account or on the Chard Snyder Mobile App.

A more comprehensive set of information about your healthcare and dependent daycare FSA

Simple chart showing what you need to know to better understand the plans.

Details how orthodontia claims are handled differently than other healthcare flexible spending account claims

Explains how the Flexible Spending Account carryover works

Explains how the flexible spending account grace period works

Explains why you might receive a request for additional information about an expense that you paid for with your benefits card

Utilice este formulario para presentar reclamos para su salud o para dependientes de guarderías de su cuenta de gastos flexibles.

Estimate your annual healthcare or dependent daycare costs

Details on accessing the savings or spending accounts you may have