Health Care Account Service Center (Optum Bank/UnitedHealthcare) fax number

Fax destination details

Department

FSA/HRA claim processing

Purpose

Submitting FSA health care expense reimbursement claims by fax to the Health Care Account Service Center

Form

FSA Health Care Claim Form — Request for Reimbursement from your FSA for Health Care Expenses

Address

P.O. Box 740378, Atlanta, GA 30374

Voice phone

1-800-331-0480

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Attach itemized receipts or Explanation of Benefits (EOB) for each amount requested; mail or fax pages 2 and 3 of this form along with receipts; provide Your UnitedHealthcare Member ID and Group Number; include sign/date; for medical expenses, provide provider name/address, amount charged, and date of service; for prescriptions include medication name or NDC; receipts should be blue/black ink and taped to a sheet; do not send credit card receipts.

Official form instructions are published as a downloadable file on the organization's website.