Healthcare FSA or Limited Purpose FSA Claim
When using your Benefits Debit Card or paying out of pocket, you must provide documentation for each eligible expense, such as an itemized receipt or Explanation of Benefits (EOB).
Also, eligible Healthcare FSA and Limited Purpose FSA expenses for you, your spouse, or other eligible dependents must be incurred during the plan year. For specific plan information, log in to your online account.
For a doctor visit or medical procedure, documentation should include:
- Original date of service
- Type of service rendered (checkup, physical, surgery, etc.)
- Charges for the service
- Provider of the service (physician name or facility)
- Recipient of service
For drugs and medication, documentation should include:
- Copy of the physician’s prescription for over-the-counter drugs and medication
- Receipt or documentation from the pharmacy showing the prescription number and date filled
Dependent Care Account Reimbursement Claim
Eligible services must be received and paid for before filing for a Dependent Care Account (DCA) reimbursement.
When filing a DCA claim, you must provide the following during the claim process:
- The tax ID of the care provider, or
- The individual Social Security Number of the care provider