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WageWorks Claim Forms

WageWorks' easy-to-use-and-understand claim forms enable you to submit claims by mail or fax, and get reimbursed quickly. Click on the appropriate claim form you require and it will open up in any web browser. Just print it out, mail or fax it in, along with the appropriate receipts, and you're done!

If this is your first time filing a claim, you may want to check out one of the pre-populated samples. It will show you exactly what is required to complete your claim successfully.

Please note: Your employer may offer customized claim forms specific to your company. Please log in to your WageWorks account at www.wageworks.com to retrieve the appropriate form. Using the form associated with your employer's plan will ensure accurate and speedy routing and processing of your claim. You also can file a claim online to request reimbursement for your eligible expenses.

HealthCare Health Care Claim Form  |  View sample file  |  Documentation Checklist
Dependent Care Dependent Care Claim Form  |  View sample file
Commuter Commuter Claim Form

To view and print the forms, you need the Adobe Acrobat Reader installed on your computer. Adobe Acrobat Reader is free and can be run as an independent program or as a "plug-in" for most major web browsers to allow on-line viewing of PDF documents.

To download the Reader click on the "Get Adobe Reader" link below. This will take you to Adobe Systems' Web site. Follow the detailed instructions on the Adobe Web site to download and then install the software on your computer.

Get Adobe Reader

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