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Claims & Accounts Account Balances Medical Claim Summary Health Reimbursement Account Health Savings Account Flexible Spending Account(s) View Statements Other Claims Prescription Claims Dental Claims Vision Claims Mental Health Claims Member Actions Submit a Claim Appeal a Claim   Automatic Payment Options Mailing Preferences Direct Deposit Coordination of Benefits Request ID Cards Enroll in Automatic Payment from Flexible Spending Account or Healthcare Reimbursement Account Activate Enrollment Settings for plan year: 01/01/2006 - 12/31/2006 NOTE: Your enrollment will be effective today. It will not be backdated to the policy effective date. By clicking Confirm Enrollment, I authorize UnitedHealthcare to make automatic reimbursement payments from my health care Flexible Spending Account or Healthcare Reimbursement Account for expenses submitted to, but not payable by, my health care plan. I certify that expenses to be reimbursed automatically through my Flexible Spending Account or Healthcare Reimbursement Account will be incurred by me (and/or my spouse and/or my eligible dependents) and will not be reimbursed by another plan. I/we will not use the expenses reimbursed through the Flexible Spending Account or Healthcare Reimbursement Account program as deductions or credits when filling out my/our individual income tax return. I understand that any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may be guilty of a criminal act punishable under law and may be subject to civil penalties. Confirm Enrollment

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