FSA Claim Forms
Click the buttons below to open and download each form
Claim Filing Options:
File claim online: Log in to your account at takecarewageworks.com to submit your claim electronically.
File claim via fax, email, or mail: Claim details may be entered online and a completed form may be printed and faxed or
mailed with documentation. Fax: 877-782-8889, US Mail: CLAIMS ADMINISTRATOR, PO Box 14054, Lexington, KY, 40512,
Email: claims@takecareclaims.com