Click each tab to review the plan documents

 

  • 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

    NBS Health Care Expense Worksheet

  • Please complete this form and return it to National Benefit Services, LLC

    IMPORTANT! Please attach a voided check with this form (not a deposit slip). Only for a savings account is a deposit slip acceptable. If you have Direct Deposit information on file it carries forward unless corrected or rescinded in writing by you.

    NBS FSA Direct Deposit Request Form

  • Group Number: NBS716666

    Instructions For Quick Claim Processing:

    • Fully complete & sign this claim form

    • Attach copies of supporting EOB, receipts, vouchers, bills, etc.

    • All receipts must include a date, description, and amount of the service

    • Please list one expense per line

    • Please print in dark blue or black ink when using this form

    • Please allow 2 business days for claims to be processed

    FSA Claim Form