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Direct Deposit Authorization Form
IRS Publication 502 – Medical Expenses
Medical Expenses Eligible for Reimbursement
Medical Reimbursement Account Claim Form and Instructions
Notice of Privacy Practices
Over the Counter Drugs Eligible for Reimbursement
The FUJIFILM MRA, COBRA and HIPAA Customer Service Telephone line (866-444-FUJI)
operating hours are 8:30 am to 6 pm (EST), Monday through Friday, except for holidays.
These forms are published on this page by Associated Administrators, LLC
on behalf of the Client Fund and are meant solely for the use of their participants.