Request for Reimbursement Preferred HRA Form

 

To file a request for reimbursement:

  1. Complete the form using one of the following options:
    1. Fill out the form online by downloading this version:
           Request for Reimbursement Preferred FSA/HRA Form.
    2. Fill out the form by hand by downloading and printing this version:
           Request for Reimbursement Preferred FSA/HRA Form.
  2. Send or fax the completed form to:
    • Preferred Blue Accounts
      P.O. Box 11586
      Birmingham, Alabama 35202-1586
      Fax 1 877-889-3610 (Toll Free)

 

Preferred Blue Accounts Direct Deposit Service Form

 

To start the direct deposit service:

 

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