If you cannot use your MyFlex Advantage Card to pay for an expense, use your own funds to make the payment, and then submit a completed claim to UPMC Health Plan for reimbursement.

You can submit a claim using the appropriate claim form below. Complete the form, attach your receipts, and either fax, email, or send the information in the mail.

• Transit Expense Claim Form
• Health Care Expense Claim Form
• Dependent Care Expense Claim Form
• Parking Expense Claim Form
• Reimbursement Authorization Agreement
• Spouse Card Request Form
• Dependent Card Request Form
• Ceritificate of Medical Necessity