File a Limited Purpose Flexible Spending
The fastest way to file a Limited Purpose Flexible Spending Account (LPFSA) claim is through your online account or the mobile app, AFmobile®. Download AFmobile from the Apple App Store or Google Play Store.
LPFSA Reimbursement Claim
Eligible 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.
File a Claim
When filing a claim online, click on the File a Claim button on the top of the page and select Reimbursement Account(s). If you're filing a claim through AFmobile, touch the Submit Reimbursement button on the AFmobile dashboard to begin the claim process.
There are two ways to use your LPFSA funds: with your Beneﬁts Debit Card or by paying out of pocket and reimbursing yourself. Both require documentation for each eligible expense, such as an itemized receipt or Explanation of Beneﬁts (EOB).
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
Unblock Your Card
To comply with IRC guidelines, we request documentation of your expense to clearly prove the eligibility of the purchase. If you received letters in the mail requesting documentation but failed to provide it to American Fidelity, your Benefits Debit Card will be temporarily blocked. There are a few ways to get your card unblocked
LPFSA Claims FAQs
How do I file an LPFSA claim?
- Log in to your online account
- Click the File a Claim button on the top of the page
- Select Reimbursement Account
- Complete the claim form
- Click the Submit button
- Touch the Submit Reimbursement button on the AFmobile dashboard
- Complete the Claim Form
- Click the Submit button
- Fax or Mail
Eligible expenses generally must have been incurred during the current plan year. Log in to your online account or check with your employer for specific rules applicable to your plan.
When will my claim be paid?
Once your claim and all required documentation have been received, the turnaround time for claims processing is generally 5-7 business days.
How will I receive my reimbursement?
If you have signed up for direct deposit, you will receive your reimbursement funds directly in your bank account. If not, you will receive a paper check.
How can I view my balance and transaction history?
You may view your account information at any time by logging in to your online account and selecting your reimbursement account from the dashboard to view account information.
You can also view your account information from our app, AFmobile®. You will be able to view your account balance from the dashboard, or, tap on your reimbursement account to view a complete transaction history.
My transaction is marked resolved. Now what?
If your transaction is marked resolved, you’ve provided eligible documentation or made an out-of-pocket payment. No additional action is needed on resolved transactions.
Why do I have to submit receipts for every LPFSA claim?
The Internal Revenue Code (IRC) regulations have requirements stating that expenses must be substantiated using itemized receipts, third party statements, or an Explanation of Benefits. To comply with IRC guidelines, we request documentation of your expense to verify the eligibility of the purchase.
What information does a claim documentation or receipt need to include?
Your documentation should include:
- Itemized receipts for an expense
- Original date of service
- Description of service rendered or expense
- Charges for the service or expense
- Provider of the service or expense
- Recipient of the service or expense
Why did I receive a “request for documentation” letter in the mail?
You will receive a request for documentation via mail if you used your Benefits Debit Card to make a Limited Purpose FSA purchase, or if you submitted an out of pocket reimbursement claim without a receipt. You also may receive this letter if the documentation you submitted wasn’t sufficient.
These letters are sent the day after a purchase is made or when the claim is reviewed and determined to be missing documentation or containing insufficient information. So, when receiving this letter, you may have already submitted the necessary documents.
Why did I receive an “ineligible” or “insufficient documentation” letter, and what should I do now?
You will receive this letter if your Benefits Debit Card was used for an expense incurred outside the plan year, an ineligible expense, or if the documentation you submitted was insufficient.
When the documentation cannot be provided or the expense is ineligible, you have three options:
- Submit a different itemized receipt to offset the transaction amount.
- Contact American Fidelity to make a credit card payment.
- Submit a check in the amount of the transaction to be applied to your Healthcare FSA account.
If you have questions about your reimbursement account, log in to your online account or visit the support section.
If you need to file a paper claim, download and print a claim form here.
NOTE: Paper claim filing is not the fastest option. File a claim online or through AFmobile to get your money faster.