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Human Resources

Filing A Claim

If you choose not to use the PayFlex debit card, you can still receive reimbursement for eligible health care or dependent care expenses by submitting a claim form with appropriate documentation to our third-party administrator, PayFlex.

When filing your claim, you must attach copies of the receipts. The receipt must show the following items:

  • Employer Name
  • Employee Name
  • Social Security Number
  • Date of Expense (date of service)
  • Name and address of service provider
  • Expense Description
  • Person for whom expense paid
  • Amount paid
  • Receipt form provider, needs to have date of service, type of service and amount paid or owed to the provider

Cancelled checks, credit/debit card slips, or statements showing only a balance due on your account are not allowable.

To verify that your claim has been received, please go If your claim is denied, you will receive written notification mailed to your home address.

You may check your account balance status any time, day or night at

If you choose to fax your claim with receipts, the fax number is 402-231-4310. After you fax a claim and receipts, please do not follow-up with a hard copy in the mail. (Remember to keep the original claim form and supporting documents for your records).

If you choose to mail your claim with receipts, the address is PayFlex Systems USA, Inc., Flex Department, P.O. Box 3039, Omaha, NE 68103-3039. (Please remember to keep a copy of the claim form and supporting documents for your records). Please allow plenty of time for the postal service to deliver your claim.