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At Mountain States we are on a Mission:

"To satisfy our clients needs and expectations through the development of quality plans, while delivering exceptional customer service by exceptional employees."
* Flexible Spending Accounts

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Flexible Spending Account Forms

Please click on the form type below to view.

  • FSA Claim Form
  • FSA Expense Estimation Worksheet
  • FSA Eligible Expenses
  • FSA Receipt For Independent Day Care Provider
  • HRA Claim Form
  • Letter of Medical Necessity
  • FSA Claim Quick Reference Guide.pdf

    Click here to download Adobe Acrobat Reader

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    MyMSAS online may allow clients to view:
  • Claims Information
  • Coverage Verification
  • Flexible Spending Account Balances

    • MyMSAS Online Registration Instructions

    		 

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