Claim Form for Group Healthcare Reimbursement Account

Other

Use this form to request medical expense reimbursement following severance from employment.

Download: By Mail

Security Benefit
Retirement Plan Services
P.O. Box 750600
Topeka, KS 66675-0600
United States

Overnight Delivery

Security Benefit
Mail Zone 560
One Security Benefit Place
Topeka, KS 66636-0001
United States

By Fax

866.477.6526

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