HEALTH CARE CLAIM FORM PO Box 36880 Use only CAPITAL LETTERS Louisville, KY 40233 WKBVDY FAX TO: 1-866-643-2245 TOLL-FREE or 1-502-267-2233 PHONE: 1-877-FSAFEDS For additional expenses, please use next page. (1-877-372-3337) TTY:1-800-952-0450 SECTION 1: EMPLOYEE ...