Reimbursement Account Information for Members
Allegiance offers third party administration of Flexible Benefits Plans (FSAs), Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs), and qualified transportation plans (Parking and Mass Transit). We place priority on accurately processing claims and reimbursing members promptly.
- Debit Card Information
- HSA Advantage
- Flex Advantage $550 Rollover
- Flex Advantage Grace Period
- Limited Expenses
- Medical Expenses
- Appeal Rights
- Medical Information Release Authorization
- Mobile App and Website Login Instructions
- Health FSA Reimbursement Request Form
- Orthodontic Expense Form
- Dependent Care FSA Reimbursement Request Form
- Daycare Reimbursement Contract
- Limited Purpose Reimbursement Request Form
- Mass Transportation Reimbursement Request Form
- Parking Expense Reimbursement Request Form
- HRA Claim Form / Expenses
- HRA Claim Form / Deductible Expenses
- Información de la Tarjeta de Débito
- Ventaja de HSA (Cuenta de Ahorro de Salud)
- Ventaja de Gastos Flexibles $550 de Traspaso
- Periodo de Gracia de Ventaja de Flex
- Gastos Médicos
- Derechos de Apelación
- Autorización para Revelar Información Médica
- Instrucciones para la Aplicación Móvil y Sitio Web
- Formulario de Solicitud para el Reembolso de la Cuenta de Salud FSA (Cuenta de Gastos Flexibles)
- Formulario para Gastos de Ortodoncia
- Formulario para Guardería
- Contracto para Guardería
- Formulario de Solicitud para el Reembolso de Propósito Limitado
- Formulario para Gastos de Transporte Masivo
- Formulario para Gastos de Parqueo
- Formulario para Gastos de Reembolso de Salud
- Formulario de Reclamo HRA (Cuenta de Reembolso de Salud) / Gastos Deducibles
Your Allegiance account profile will be updated to include this email address for communication purposes. Please contact Customer Service if you do not wish your account to be updated.
Reimbursement Account Information for Employers
Allegiance offers third party administration of Flexible Benefits Plans (FSAs), Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs), and qualified transportation plans (Parking and Mass Transit). We place priority on accurately processing claims and reimbursing members promptly.
- Health FSA Reimbursement Request Form
- Orthodontic Expense Form
- Dependent Care FSA Reimbursement Request Form
- Limited Purpose Reimbursement Request Form
- Daycare Reimbursement Contract
- Mass Transportation Reimbursement Request Form
- Parking Expense Reimbursement Request Form
- HRA Claim Form / Expenses
- HRA Claim Form / Deductible Expenses
Your Allegiance account profile will be updated to include this email address for communication purposes. Please contact Customer Service if you do not wish your account to be updated.
Reimbursement Account Information for Brokers
Allegiance offers third party administration of Flexible Benefits Plans (FSAs), Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs), and qualified transportation plans (Parking and Mass Transit). We place priority on accurately processing claims and reimbursing members promptly.
Your Allegiance account profile will be updated to include this email address for communication purposes. Please contact Customer Service if you do not wish your account to be updated.