Editable FSA Forms (July 13, 2019)

Gail Breeland has shared editable FSA forms she uses to submit FSA claims to Raytheon Benefits.

There are forms for both the Apple Pages Application and Microsoft Word:

• Word FSA Claim Form
• Apple Pages FSA Claim Form

The Vendor column is an addition to the Raytheon published FSA Form. Gail uses the vendor column to list where the expense was incurred. (example: Medicare; supplemental insurance vendor; prescription vendor; name of pharmacy; name of hospital; etc).

The forms are also available under the Forms/Benefits Menu Tab