State Farm Flexible Spending Accounts
For State Farm Employee Use Only

Health Care Flexible Spending Accounts (HCFSA) and Dependent Care Flexible Spending Accounts (DCFSA)

State Farm's Health Care Flexible Spending Accounts (HCFSA) and Dependent Care
Flexible Spending Accounts (DCFSA) give eligible employees the opportunity to use
pre-tax dollars to pay for eligible medical and dependent care expenses. Participating employees do not pay Federal income taxes, State income taxes (in most states), or
Social Security taxes on contributions to or distributions from HCFSA and DCFSA.

About Your Benefits

• Frequently Asked Questions
• Decision Support Tool
• Health Care (HCFSA) Overview
• Health Care (HCFSA) Expense List
  - Orthodontia Expenses
• Dependent Care (DCFSA) Overview
• Dependent Care (DCFSA) Expense List
• Notice of Privacy Practices
• Summary Plan Descriptions:
  - Dependent Care (DCFSA)
  - Flexible Compensation
  - Health Care (HCFSA)

Submitting A Claim

• Login Instructions
• Claim Forms:
  - General Information
  - DCFSA Blank Claim Form
  - HCFSA Blank Claim Form
• Physician's Statement
• Sample Documents
• Fax toll-free to: (866) 863-6598
  - Tips for Faxing
• Or mail to:
  Ceridian Reimbursement Services
  P.O. Box 534385
  St. Petersburg, FL 33747-4385