Instructions For Quick Claim Processing:

This worksheet is for estimating annual health care expenses only.

• Enter your annual cost for each health care option you use

• Add up the Total Annual Health Care Expense

• Determine your yearly Number of Pay Periods = Weekly/52, Bi-Weekly/26, Semi-Monthly/24, Monthly/12

• Divide the Total Annual Expense by the number of pay periods to calculate the amount needed to be withheld every pay period

Click the button above to open and download the form