Did you pay out-of-pocket on an eligible expense? Here’s how you can submit a claim to get reimbursed.
From your Surency Member Account:
- Once you’re logged in to your Member Account, from the Home tab, select Reimburse Myself.
- To request an HSA distribution, select My HSA in the From option. Fill out all the required fields and click Submit. If you wish to have your distribution check made out to your provider, you should select Someone Else as the To option. Then enter your provider’s name in the Recipient Name box.
- To make a post-tax HSA contribution, instead of Step 2, select My HSA as the To option and fill out all required fields. Make sure you don’t go over the maximum contribution allowed by using the chart available on the form.
Print a Distribution Form:
- Select the Tools & Support tab at the top of the page.
- Click on HSA Distribution Request Form to download and print a distribution form.
- Follow the instructions on the form, fill it out completely, and submit it to us for processing.
From the Surency Flex Mobile App:
- From the Home screen, select Reimburse Myself.
- Select your HSA account
- Select your payment method
- Fill out the remaining required fields on the claim form and click Submit to finish the claim filing process.