For Medical FSA Claims:
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:
- 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
Receipt Examples:
Explanation of Benefits (EOB) from insurance provider will have all of the needed information above. If you do not have your EOB you may also provide receipt directly from provider.
YES | NO |
|---|---|
 | A credit card payment receipt is not sufficient documentation as it does not provide details on the service date. (exception: Pharmacy receipt for Rx purchase is acceptable)
|
For Dependent Care Claims:
Receipt Requirements
- Date services were rendered
- Name of service provider
- Amount charged
- Name of person receiving service (dependent)
- Tax ID# or SSN of the provider
You may also provide completed claim form with caregiver signature in lieu of an invoice. Claim forms can be accessed in the Tools & Support page of your online account.
Tuition Claims:
Most tuition plans require:
- Receipt of payment. (Invoice must show payments equal to the claim amount not including scholarships and grants)
- Course Grade to show course completion. (Plan may have minimum grade requirement - please review plan's requirements)
- Any other documentation required by Employer plan - Not common. (Each plan, if offered, is unique by employer. Please check your plan's requirements for additional documentation needs)
