Benefits Administration Planning Vita Home
 
VitaFlex®: How to File a Claim

Submitting Reimbursement Requests
VitaFlex® reimbursement requests may be submitted via either of the following methods. If faxed, do not re-submit a hard copy through the mail. Faxed forms are typically processed faster.

Mail To:
Vita Administration Co.
900 North Shoreline Blvd
Mountain View, CA 94043-1933
Fax To:
Vita Administration Co.
650-964-FLEX (3539)

Reimbursement Guidelines
1. Complete all the information on the claim form. Each claim form must be signed and dated. Complete documentation of expenses must be provided with each claim.

2. Please retain a copy of the claim form and supporting documentation for your records.

3. Most claims are processed within 2 to 3 business days. Faxed claims are processed faster--typically in one business day.

4. After your claim is processed, you will receive an Explanation of Benefits (EOB) which identifies when you will receive reimbursement.

5. Claims may be submitted as expenses are incurred, or they may be bundled and submitted periodically throughout the Plan Year.

6. All claims for the prior Plan Year must be received by the claims submission deadline to be considered for reimbursement. In order to receive reimbursement, the complete documentation must be submitted by the claims submission deadline. Please reference your employer’s Summary Plan Description for your specific claims submission deadline.
Claim Examples
Medical FSA (PDF)
  Office Visit Copay
  Therapy Services
  Vision Services
  Orthodontia Services
  OTC Item Clarification

Dependent Care FSA (PDF)
  Daycare
  Daycare with Receipt