Medical Reimbursement Form - Use this form to file a manual request for reimbursement.


Medical Mileage Log- Attach this form to your reimbursement form to be reimbursed for Medical Mileage.

Direct Deposit Form - Fast and Easy!! Why wait on the mail to receive your reimbursement check. Use the Direct Deposit Form to set up your Direct Deposit today.

Dependent Care Acknowledgement Form - Use the Dependent Care Acknowledgement Form, to claim your annual DCA account amount.

Medical Necessity Certification - According to the IRS rules and regulations that govern your FSA program, some medical products and services are only eligible to be reimbursed when your doctor or health care provider deems them medically necessary. The provider must indicate your (or your spouse or dependents) medical diagnosis, what treatment is needed, and how this treatment might alleviate your medical condition.

Change of Address Form - Use this form to change your email and/or mailing address.

Additional Febco Card Request Form

Proof of Insurance Form - Use this form to provide Febco with proof of insurance. This is not a reimbursement request, only proof.