• Request Reimbursement

    You should file your claim for reimbursement as soon as possible after you have incurred the expense. 

    Your claim for expense reimbursement must include:

    1. a statement from your service provider that you have incurred the expense
    2. the amount of your expense.

    Note: In some instances, a statement from the provider that an HRE expense is medically necessary may be required.

    How to submit a claim

    There are two ways to submit a claim: 

    1. Submit your claim electronically through the FSA/HRA consumer portal.  

      • Scanned copies of your expense information is required to submit your claim electronically.

    2. Complete a Reimbursement request and submit by mail or fax: 

    Claims address

    PacificSource Administrators, Inc.
    PO Box 2797
    Portland, OR 97208


    (866) 446-6090  


    If you have any questions, feel free to call our Customer Service Department at (800) 422-7038 or email psacustomerservice@pacificsource.com.