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What Information is Required For Claim To Be Approved?

In order for your claim to be in good order there is specific detail that is required. When submitting a claim be sure to include a receipt or Explanation of Benefits (EOB) with the following information:

For Medical FSA Claims:

  • Date service was rendered (Medical FSA claims are based on date of service, not date of payment, with the exception of orthodontia which is based on payment date)
  • Description of service or item
  • Name of provider of service
  • Name of person receiving the service
  • Total out-of-pocket cost
  • A credit card payment receipt is not sufficient documentation

For Dependent Care Claims:

  • Date services were rendered
  • Name of service provider
  • Amount charged
  • Name of person receiving service (dependent)
  • Tax ID# or SSN of the provider
  • Signature of the caregiver on claim form or receipt from caregiver