Where Do I Find a Claim Form?

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Where Do I Find a Claim Form?


Claims can be submitted online or can be faxed/mailed into Superior State (How? Click Here).  The appropriate claim forms for the various benefit plans we administer are linked below:

FSA Claim Form (For Health FSA, Dependent Care FSA, or Premium Reimbursement FSA).

HRA Claim Form (For HRAs, MERPs, Deductible Reimbursement Plans).

Commuter Claim Form (For Parking and/or Transit Plans).

HSA Claim Form (For Health Savings Accounts)


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Last Modified:5/2/2014 3:08:13 PM

Last Modified By: Kevin_Murphy

Type: INFO

Level: Novice

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