1 (877) 772 - 0415
SF MRA Enrollment Form
Complete this form to determine if you qualify for a Medical Reimbursement Account (SF MRA). After you submit this form, SF City Option (SFCO) will let you know if you are eligible for SF MRA within 1-3 weeks.
If you have any questions, please call Customer Service at 1(877) 772-0415 Monday through Friday, 8:30am-5:30pm Pacific Time or email email@example.com.
* Required Fields
Date of Birth
Social Security Number *
We only use the provided information, including your SSN, to match your enrollment to employer contributions.
If you have any questions or concerns, please call SF City Option Customer Service at 1 (877) 772-0415 or email firstname.lastname@example.org.
By providing your phone number and/or email address you agree to receive emails or calls from the SFCO program. If you want to stop receiving SFCO calls and/or emails, please call Customer Service at 1 (877) 772-0415 or email email@example.com.
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