Personal Choice Flexible Spending Account
For those participating in pre-taxed spending paycheck deductions for medical related expenses. Reimbursement forms can be scanned and emailed to pcacla
FORMS
- Status Change Form: For changes in address and other personal information. Changes in deductions can only take place during open enrollment or with a qualifying event.
- Flexible Spending Account Claim Form: For reimbursement of medical/vision, dental, prescription, massage therapy, over-the-counter and orthodontic expenses.
- Dependent Care Reimbursement Claim Form
- Personal Choice Account Direct Deposit Form: To authorize reimbursements from Personal Choice to be directly deposited to your checking/savings account.
Personal Choice Enrollment Form - Regence BCBS
(44 KB)
Use for new enrollment only. To be completed and returned to HR for processing.
Published May 19, 2008
