Filing Claims for FSA Health Care Expenses

Attach copies of receipts from service providers or the Explanation of Benefits Form from an insurance carrier to the claim form. The documentation from the service providers must contain the following information:

Name of the provider
Patient Name
Date of Service
Description of Service
Amount charged

NOTE:
A "Paid Receipt" is not sufficient documentation unless it includes the five items listed above.

The Health Care FSA reimburses your and your eligible dependents’ medical and dental expenses. These medical expenses must qualify under Internal Revenue Code Section 213. Eligible “medical care” expenses include amounts paid for diagnosis, treatment or prevention of disease. The expense must be to alleviate or prevent a physical defect or illness.

Below are lists of common expenses that are Eligible, Ineligible or Require Additional Documentation. For a complete list of eligible expenses, review the IRS Publication 502 available at your local IRS office or at the IRS web site at http://www.irs.gov/pub/irs-pdf/p502.pdf. Please note that insurance premiums are not eligible for reimbursement under an FSA.

View List : Eligible Health Care Expenses

View List : Expenses Requiring Additional Documentation

View List : Ineligible Health Care Expenses