Participant Information

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Filing Claims

The following participant forms for filing claims can be downloaded and printed from this Web site.

Claim Form

Systematic Premium Reimbursement Form

Direct Deposit Enrollment Form

Click here to view and print forms.

Please keep a copy of the form for your records. You may mail, fax or e-mail form and claim verification to the Third Party Administrator:

Mail to
HealthSecure HRA
Third-party Administrator
P.O. Box 27810
Minneapolis, MN 55427-0810

Questions
Toll-free: 1-888-364-5027
Fax: 763-582-3471
E-mail: myHealthSecureHRA@meritain.com

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Securities and investment advisory services are offered by VALIC Financial Advisors, Inc., member FINRA and an SEC-registered investment advisor.

Securities and investment advisory services are offered by VALIC Financial Advisors, Inc., member FINRA and an SEC-registered investment advisor.

VALIC represents The Variable Annuity Life Insurance Company and its subsidiaries VALIC Financial Advisors, Inc. and VALIC Retirement Services Company.

This information is general in nature and may be subject to change. Neither VALIC nor its financial advisors or other representatives give legal or tax advice. Applicable laws and regulations are complex and subject to change. Any tax statements in this material are not intended to suggest the avoidance of U.S., federal, state or local tax penalties. For legal or tax advice concerning your situation, consult your attorney or professional tax advisor.

www.valic.com/hra

Last Updated: 4/5/2010