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Interfas
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Employee Benefits Administrator
Secure access
Administrator
Flextr@net
Insurer
Member
Submit a claim
Consult my payment slips
Our services
Administrators
Concept
Flextr@net
About us
Reimbursement request and
direct deposit registration
Health Care Spending Account
Cost Plus Account
Ded/Co
Are the costs incurred as a result of an accident at work?
yes
no
Are the costs incurred as a result of an automobile accident?
yes
no
Details of the member
Incurred expenses
Submit a claim for your Cost Plus or Health Care Spending Account: :
If your insurance contract does not cover the submitted expenses,
attach the original of each receipt
. If it's a claim for dental care, please attach the dentist form duly completed.
If your insurance contract covers part of the submitted expenses,
attach a copy of each receipt
and
the payment slip of insurer
.
Submit a claim for your Ded/co:
Attach a copy of each payment slip from the insurer detailing the deductible and/or co-insurance
Individual
Name
Date of birth
Total
---
Insured
Spouse
Child
Student 21 and +
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Insured
Spouse
Child
Student 21 and +
---
Insured
Spouse
Child
Student 21 and +
---
Insured
Spouse
Child
Student 21 and +
---
Insured
Spouse
Child
Student 21 and +
---
Insured
Spouse
Child
Student 21 and +
---
Insured
Spouse
Child
Student 21 and +
Total
I HEREBY CERTIFY THAT ALL INFORMATION CONTAINED HEREIN IS TRUE TO THE BEST OF MY KNOWLEDGE AND THAT ALL EXPENSES WERE INCURRED BY ME (OR MY DEPENDENTS) FOR THE EXCLUSIVE USE OF THE PERSON NAMED.
Pre-authorized Registration
Electronic copy of voided check
Transmission of receipts
Attach a copy of all your receipts
With the voided check, I authorize Interfas inc. to make deposits in my bank account.
Please note that the reimbursement of benefits by check is made on the last Friday of each month.
Contact us
1 866 877.7243
Concept
Flextr@net
About us
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