Flexible Spending Plan – PEHP
|PEHP FLEXIBLE SPENDING FORMS|
|Flexible Spending This claim form is for reimbursement of qualified medical expenses that have been paid out of pocket for the employee and/or family member on their plan.||Flexible Spending Reimbursement Claim Form (PDF)|
|Flexible Spending Salary This form is used to communicate the amount to be deducted from an employee’s salary that will be contributed to a Flexible Spending Account for medical expenses for the Fiscal Year.||Flexible Spending Salary Authorization Form (PDF)|
Dixie State University offers a Flexible Spending Plan through Public Employees Health Plan (PEHP). Complete benefit summary information and forms are available on the PEHP website. Access PEHP’s website at www.pehp.org.