©2016 Pension Dynamics Company LLC. All rights reserved.
FLEXIBLE BENEFIT CLAIMS
Phone: (925) 956-0514
Fax: (844) 859-7309
The best way to check your claim status is to log into your account online at
www.pensiondynamics.com. If you have not yet registered for an account, please contact
Pension Dynamics Company LLC. The website is available 24/7 and is a great resource
once you have registered.
Customer Service is available at (925) 956-0514 from 8 AM - 5 PM PST, Monday - Friday.
You can also email us at email@example.com. Please include your name and
your employer name on any correspondence sent to us but do not include confidential
information such as your Social Security Number.
2300 Contra Costa Blvd., Suite 400
Pleasant Hill, CA 94523
Tips for Completing the Claim Form
• Fill out each section completely. Any incomplete forms will not be able to be processed.
• Type or write legibly.
• Don't forget to sign your form. The employee who is participating in the plan is required to sign the form, not your spouse or other dependent.
• Insurance Coverage: If insurance is paying ANY portion of the services that you are requesting reimbursement for, please check YES. If you do not
have insurance or if this item is not covered by your insurance, please check NO.
Things to Include with your Claim Form
• All Health Care substantiation must include:
Name of patient (you, your spouse or tax dependent) incurring the expense
The date services were provided or the date the item was purchased
Service Provider or Merchant Name
Description of Service/Purchase
Amount of Service/Purchase
An Explanation of Benefits (EOB) is recommended. If you have insurance coverage that is covering a portion of the services the EOB is sometimes
• All Dependent Daycare substantiation must include the following:
Dates of Service (dates care provided, not when billed/paid for)
Description of Service
Care Provider’s Name
Provider’s Tax ID or SSN
Amount of Claim
If your provider does not give receipts Pension Dynamics can accept the provider's signature on the completed claim form as proof of your expense.
• Canceled checks, credit card receipts, and statements including "Previous Balance", "Balance Forward, or "Paid on Account" are NOT acceptable as
they do not contain all of the required information.
• Handwritten statements must be on provider’s letterhead or have a provider stamp containing their information.
Reminders for Submitting your Claim Form:
• Retain the original of all requests including the substantiation, sending us a copy of the documents only. Pension Dynamics is not responsible for
• Please allow 2 business days for your claim to be processed. Payments are not able to be issued until services have been incurred in full.
• If your claim is denied, you will receive a written statement telling you why the claim could not be processed. If we need further information the
denial letter will state what you can do in order to have your claim re-processed.
• Do NOT combine your claim with your co-workers' claims. It will cause a delay in processing and may not be processed at all.
• If possible, scan your Claim Form and all substantiation and email the documents to us at firstname.lastname@example.org. This is the preferred
method of claim submission as you will get a personal response back stating your claim was received.
• You may also Fax your Claim Form to (844) 859-7309
• If you mail your Claim Form please send only copies, not originals, to: Pension Dynamics Company LLC, Attn: Benefits Department,
2300 Contra Costa Blvd., Suite 400, Pleasant Hill, CA 94523-3987.
Important information before you begin