Welcome to the Help Center

What Information is Required For Claim To Be Approved?

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. 



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)