How do I print an FSA Claim Form without logging into MyEnroll360?

You can obtain an FSA claim form without logging into MyEnroll360.

How to get the claim form

1. Go to www.myenroll.com
2. Click on the “Forms” button (you don’t need to log in).
3. Download the FSA Claim Form you want (medical or dependent day care).

How to submit the completed form

1. Fill out the form completely and attach your supporting receipts.
2. Submit the form using one of the following methods:
   • Email: Send to [e-mail].
   • Fax: Send to 1-888-265-2144.
   • Mail:     Benefit Allocation Systems

Attn: FSA Claims Department

PO Box 62407

King of Prussia, PA 19406

Need Help?

If you have questions or encounter issues, contact Customer Service:

• Email: [e-mail]

• Phone: [phone]