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Title:	MGM Benefits Group - Dependent Care Reimbursement Claim Form
Summary:	2010-11
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Keywords:
Handle:	Document-4754
Owner:	McCabe, Perry (User-18, pmccabe:DocuShare)^DS
Create Date:	Thursday, August 5, 2010 11:30:22 AM CDT
Modified Date:	Thursday, August 5, 2010 11:30:22 AM CDT
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Abstract:	MGM Benefits Group 2121 N. Glenville Drive ? Richardson, TX 75082 ? Phone: (800) 833-4028 ? Fax: (800) 973-3702 ? FlexSupport@MGMBenefits.com Flexible Benefits Dependent Care Reimbursement Claim Form Instructions for Online Claim Filing Claims may be filed online at www.mgmflex.com. Log into your account and enter your claim information under the “File Claims” section. Instructions for Manual Claim Filing Please print or type all information for manual claims request. Attach copies of invoices for day care expenses. Date Service Incurred Dependent Name Date of Birth Description of Service (e.g., day care facility, day camp, etc.) Amount Requested Total Requested
Add Versions:	Allowed
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Content Type:	Adobe Portable Document Format (.pdf) - application/pdf
File name:	DCAP Reimbursement Form.pdf
Is Placeholder:	No
Max Versions:	4
Size:	67607
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Ready for Declare:	No
Appears In:	Section 125 and Insurance Forms, 403(b) & 457 Info., and Related Web Sites
Preferred Version:	MGM Benefits Group - Dependent Care Reimbursement Claim Form