Flexible Spending (Reimbursement) Account

Employee Benefit Specialists (EBS)

This optional program, also called a Flexible Spending Account, allows employees to set aside pre-tax dollars to pay for out-of-pocket eligible expenses. Requires yearly re-enrollment during an open enrollment period. Click here for detailed information about this program, including examples of expenses, tax savings and uses of the accounts.

Contact Information

Customer Service (Mon-Fri, 8:00 AM - 5:00 PM PST)
1-888-327-2770 or custserv@ebsbenefits.com
PO Box 11657
Pleasanton, CA 94588

Account information 24 hours/7days
1-800-327-3539 or www.ebsbenefits.com  
Please note: EBS has implemented a new security system online; when logging in you will need to click "new user" to select a new user name and password.

Filing Claims

Please use this Medical/Dependent Care Expenses Claim Form. Make sure all of your receipts contain the following information:

• Itemized billing from provider
• Name of provider or organization providing day care service
• Tax ID number or social security number of care provider
• Name of person for whom services are being provided
• Date of services
• Cost of services

If any of this information is missing, EBS must request additional details before processing your claim. IRS guidelines require us to have this information for all claims to avoid penalties in the event the plan is audited.

Dependent Care Claims

As an alternative to filing a claim for dependent care each month, for your convenience we have a Dependent Care Assistance Plan Bill from Provider.

Rather than filing claims each month, simply have your provider complete and sign this form then submit it once each year. EBS then automatically sends out your day care reimbursement each time we receive contribution information for you. This will greatly speed up the reimbursement process.

Direct Deposit

To further hasten reimbursement, just complete the Flex Reimbursement Direct Deposit Authorization for your checking account then send it in with your next claim.

Once your claim is processed, the funds are generally deposited into your bank account within 24-48 hours. You don't have to wait for your check to arrive to have the funds available to you.

PDF Forms

Forms on this site are designed to be filled out by hand or on your computer, printed out, and mailed to the appropriate office. Due to the limitations of the free Adobe Acrobat Reader software you will be unable to save your changes unless you have a full version of Adobe Acrobat.