Attention: Recently, security researchers have identified vulnerabilities in the TLS 1.1 encryption used by most websites to secure information online. Starting Friday, December 15th, 2017, Allegiance will require users to utilize a web browser with TLS 1.2 or later enabled. These advanced protocols offer increased security for your health information. Please update your browser to a version that supports TLS 1.2 or later or to the most current version; older browsers will be unable to access Allegiance websites.

Submit an HRA Reimbursement Claim

Contact Info
( ) - x
Health Claim Information
Total Charges:
Upload Files

Accepted File Types: jpg, pdf, png, tif
Size Limit: 10MB per file

Uploads: 0
Upload Size: 0
Additional Comments
I certify that the claimed expenses were incurred to diagnose, cure, treat, mitigate, and/or prevent a disease and cover only me, my tax dependents, and/or spouse (if filing federal taxes jointly). These expenses have not previously been reimbursed under any plan and I will not seek reimbursement under any other health plan. I understand that items purchased merely to promote general health are not reimbursable. I further understand that expenses reimbursed by FLEX may not be claimed on my individual tax return at the end of the year.