The easiest and most secure way to submit a claim is to log on to your account on the participant portal or on the mobile app (download here: Apple or Android). Once logged in either place, look for “I want to” and choose “File a claim.” Follow the steps to upload your documentation and enter your claim details. Important note: if you are submitting requested documentation to substantiate a debit card transaction, please don’t submit a new reimbursement claim – there’s a chance your claim could be duplicated. Instead, look for the “Receipt needed to approve your claim” item in your Tasks menu, and upload the documentation right to the transaction.
If you don’t have internet access or an app-capable mobile device, you may download and use this claim form.
When you use your ProBenefits Debit Card, funds are withdrawn from your account and paid directly to the provider, allowing for “cashless” transaction. Reimbursement is only paid directly to you when you have paid for an expense out-of-pocket using a form of payment other than the Debit Card, and submitted documentation as a reimbursement claim on https://my.probenefits.com or on the mobile app.
To answer this question, it helps to know the basics of how Direct Deposit works:
Based on this process, the funds should post in your account one to two days after the payment is created. Normally, the amount will show up as a “pending deposit” on the morning following the payment date unless there is an unusually high workload at the Federal Reserve Bank or other unusual factors.
For Daily Direct Deposit, claims are processed within one to two business days of receipt, and payment for a valid claim is generated and sent to the bank the business day after the claim is processed.
For Weekly Direct Deposit, our commitment to you is “In by Friday, Out on Wednesday.” This means that any valid claim we receive by Friday is processed (sent to our bank) the following Wednesday.
For Monthly Direct Deposit, we process payments the Wednesday immediately preceding the 15th which meets our promise of “In by the 5th, Out by the 15th.”
Not sure what payment schedule your plan is on? No problem! You can see the expected payment date on the web portal for any claims you’ve submitted.
To be eligible for FSA reimbursement, an expense must meet the following criteria:
ProBenefits also checks to determine if :
“These expenses were incurred (have a date of service) by me and/or my spouse or eligible dependents during the plan year while I have been a covered participant and to the best of my knowledge are reimbursable by the plan. I, the participant, certify that I have not been reimbursed for the above expense(s) and that I will not seek reimbursement under any other plan covering health benefits, such as my spouse’s health plan. I understand that the expense for which I am reimbursed may not be used to claim any income tax deduction or credit. I also understand that privacy regulations prohibit ProBenefits from discussing claims with anyone other than the participant.”
Sometimes, an FSA reimbursement request must be denied. Common reasons include:
Participants receive either email notification or a letter in the mail which thoroughly explains the problem(s) with their claim and provides instruction, as appropriate, toward the successful submission of their claim.
Participants should be aware of the most common claims problems that delay or prevent FSA reimbursements:
Quick reimbursement is our goal at ProBenefits, but we must adhere to all requirements to keep your plan legally compliant and audit-ready. These few simple mistakes cause most of the delays.
Please give your claims a “4-Point Inspection” before submission. Thanks!
As of January 1, 2011, over-the-counter (OTC) drugs and medicines require a prescription for reimbursement. Learn more in our blog post.
Current IRS regulations concerning Medical Flexible Spending Accounts (Health FSAs) create a confusing situation for participants regarding reimbursement for prenatal care and child delivery expenses.
IRS rules are very strict that eligible expenses may only be reimbursed by an FSA plan after the expense has been incurred. As an example: if a participant in a calendar year FSA plan pays $2,000 in delivery charges on June 1st, but the child is not delivered until July 20th, the delivery charges are not eligible for reimbursement until after July 20th.
In addition, there is a plan year limitation. IRS rules only allow reimbursement for services incurred during the active plan year. In the example above, any prenatal care expenses incurred prior to January 1st of this year would not be eligible for reimbursement in this plan year. Only services incurred January 1 – December 31 are eligible.
A receipt for services rendered showing the date of service, type of service, and amount of expense is required for claim reimbursement or debit card charge documentation. If your dependent care provider doesn’t have that type of receipt, you can print our Dependent Care Receipt Form and have them complete it. You may use this for documentation for dependent care expenses paid with your ProBenefits Debit Card, or to get reimbursed for expenses not paid with your card. Log on to your account at ProBenefits.com or on the mobile app to upload requested debit card documentation to the transaction (in Tasks on your account), or submit a reimbursement claim (I Want To: File A Claim).
Whereas IRS rules generally prohibit reimbursement for prepayment of expenses (including one-time lump sum payments for medical services not yet incurred), the current regulations include an exception for orthodontia that allows participants to be reimbursed for prepayments for qualified expenses. To learn more about using your FSA to pay for braces and other orthodontia, read our blog post on the subject.
We have a list of many common FSA-eligible/reimbursable expenses available here. While the list is certainly not exhaustive, it includes many of the items and services plan participants ask about most often.
Any procedure (including cosmetic surgery) that is directed at improving the patient’s appearance and doesn’t meaningfully promote the proper function of the body or prevent or treat illness or disease would not be eligible for reimbursement. There is an exception, however, for procedures necessary to ameliorate a deformity arising from congenital abnormality, personal injury from accident or trauma, or disfiguring disease. These may be reimbursable with a physician’s letter of certification recommending the procedure to treat a specific medical condition. Your doctor may provide you with certification on letterhead from their office, or you may provide this Letter of Medical Necessity form for your doctor to complete.
According to IRS regulations, if a doctor prescribes use of a special type of mattress to treat a specific medical condition, then with the doctor’s prescription as documentation to support the expense, the expense would be reimbursable. The IRS does impose certain restrictions on such reimbursement. For instance, the IRS limits the amount of reimbursement to the amount that the special mattress costs over and above a regular mattress. There are different ways to determine this amount, the simplest of which would probably be comparing the cost of the special mattress against a standard brand-name mattress of similar size.
The IRS also limits an item of this type to use by the participant needing the special assistance. Therefore, hypothetically, if two people were going to share a bed, theoretically only half of the cost of the bed would be reimbursable.
You can see from this explanation that this type of expense depends greatly on the facts and circumstances of the specific situation. We are available to further discuss the situation, and we will assist in every way possible to ensure that if you make a claim for such an expense it is processed and addressed as efficiently and accurately as possible, to protect you (in case of subsequent IRS personal audit) and the plan.
The cost of a wig purchased upon the advice of a physician for the mental health of a patient who has lost all of his or her hair from disease would be reimbursable.
We would need a letter from a physician stating that the wig is required due to a specific medical condition. The letter should be on the physician’s letterhead with clear reference to the specific case. It can be brief and does not have to go into detail or great substantiation. It simply must recommend the wig to treat a specifically diagnosed medical condition. Submit the letter along with a provider receipt for your claim.
Amounts paid to a special school or specially-trained teacher for a learning-disabled child are reimbursable if recommended by a doctor.
We will need a letter from the child’s physician stating that the special school is recommended to treat the specific disability (dyslexia, etc.). The letter should be on the physician’s letterhead with clear reference to your child’s case. It can be brief and does not have to go into detail or great substantiation. It simply must recommend the special school or specially-trained teacher for your child, to treat a specifically diagnosed condition. Or you may provide your doctor with this Letter of Medical Necessity form to complete. We’ll keep the letter on file, and as expenses are incurred, you can submit a provider receipt along with your reimbursement claim. A new physician’s statement will need to be submitted each plan year.
IRS Publication 502 (2006), “Medical and Dental Expenses”, states in pertinent part:
You can include in medical expenses the cost (tuition, meals, and lodging) of attending a school that furnishes special education to help a child to overcome learning disabilities. A doctor must recommend that the child attend the school. Overcoming the learning disabilities must be a principal reason for attending the school, and any ordinary education received must be incidental to the special education provided. Special education includes:
You cannot include in medical expenses the cost of sending a problem child to a school where the course of study and the disciplinary methods have a beneficial effect on the child’s attitude if the availability of medical care in the school is not a principal reason for sending the student there.
IRS Publication 502 is available from the IRS Web Site: http://www.irs.ustreas.gov/formspubs/index.html
This publication addresses itself primarily to those medical expenses deductible by a taxpayer who can itemize medical deductions as a result of these expenses exceeding 7.5% of adjusted gross income. However, this list closely parallels those expenses reimbursable by a Medical/Dental/Vision Care FSA with some exceptions.
Often, one cannot find specific reference in a tax guide to a given expense in question, and the answer must be inferred from information that is given. In this instance, the answer about special schools above gives us comfort to approve a reimbursement request for a special camp for a mentally impaired or physically disabled child, if the main reason for the child’s being there is the resources the camp has for relieving the mental or physical disability.
Please note that we believe the reimbursement is permitted under the Medical/Dental/Vision Care FSA, not the Dependent Care FSA, where overnight camps are flatly ineligible. This ineligibility as a dependent care expense holds even if the camp separately allocates the expenses for day time and overnight activities. The key criteria prohibiting such reimbursement appears to be the IRS view that this expense is not employment-related, and their refusal to entertain any attempts to allocate the overall expense into qualifying and non-qualifying categories.
Please remember that in such areas as these, interpretations are required and these interpretations can differ even among knowledgeable professionals. The exclusion from income of such a reimbursement received through an FSA must ultimately withstand potential scrutiny of an individual tax audit.
Because saline, enzymes, storage solutions, and related supplies are considered necessary for the proper care and use of prescription lenses, they are a reimbursable expense. No prescription or doctor’s note is required.
In almost every case, no.
Expenses incurred merely to improve the taxpayer’s general health are not reimbursable by an FSA when unrelated to a treatment plan for a specific illness or injury.
The term “medical care” is defined by Treas. Reg Section 1.213-1(e)(1)(i) to include expenditures incurred “for the purpose of affecting any structure or function of the body… primarily for and essential to medical care.”
Health spa memberships and exercise programs, even when prescribed by a physician, are not reimbursable by an FSA, absent physician substantiation that the expense was primarily for or essential to specific medical care.
Amounts that you pay for insurance to cover medical and/or dental care (hospitalization, surgery, drugs, etc.) are not reimbursable under a health FSA, even though the underlying insurance is for medical care.
Up to $50 per night in lodging expenses will qualify if the following conditions are met: 1. the lodging is primarily for and essential to medical care; 2. the medical care is provided by a physician in a licensed hospital or medical care facility; 3. the lodging isn’t lavish or extravagant; 4. there is no significant element of personal pleasure, recreation, or vacation in the travel. In addition, you must provide us with a walk-out statement or other documentation from the provider that indicates a visit to the doctor or hospital for the dates you are claiming.
You can be reimbursed from your Health FSA for travel expenses incurred in obtaining medical care. Similar to lodging expenses, the travel must be primarily for and essential to medical care, and there must be no significant element of personal pleasure, recreation, or vacation in the travel. In addition, you must provide us with a walk-out statement or other documentation from the provider that indicates a visit to the doctor or hospital for the dates you are claiming. Most commonly, reimbursement is based on mileage driven to obtain care, at a rate determined yearly by the IRS. You can use our Medical Mileage Worksheets to calculate your medical mileage reimbursement request:
Teeth whitening is generally not an eligible expense for reimbursement – at least not if tooth discoloration is simply the result of aging and the whitening is done for cosmetic purposes. But if tooth discoloration (rising to the level of deformity) was caused by disease, birth defect or injury, expenses for teeth whitening might be reimbursable. A doctor’s letter of recommendation certifying the underlying medical condition and/or cause would be required.
Weight loss programs are eligible for reimbursement only when the expense is accompanied by a physician’s statement indicating that the program is treatment for a specifically named disease or illness. Food products are generally not eligible.
Regarding the treatment of varicose veins, the IRS guidelines for medical reimbursement indicate that if the procedure improves appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease, it is not reimbursable. A procedure may be reimbursable if it promotes the proper function of the body or prevents or treats an illness or disease. A doctor’s certification of the latter would be required before reimbursement could be made.
Massage therapy is generally not eligible for reimbursement unless prescribed by a doctor to treat a specific injury or trauma. The cost of a massage simply to improve general health is not eligible. If prescribed to treat a specific condition, a physician’s statement indicating the condition and treatment required should be submitted. Your doctor may provide you with certification on letterhead from their office, or you may provide this Letter of Medical Necessity form for your doctor to complete. This letter is valid for one year from the date written.
Amounts expended for vitamins, nutritional and herbal supplements, and natural medicines will be reimbursable only if the substance is prescribed by a physician to treat a specific medical condition. A doctor’s certification is required and must state the supplement by name and the medical condition for which it is intended to treat. Your doctor may provide you with certification on letterhead from their office, or you may provide this Letter of Medical Necessity form for your doctor to complete. This note is valid for one year from the date written.
Once care is provided, most registration fees are eligible if they are required for care to be provided.
No, overnight camps are not eligible for reimbursement, even if you separate the expense for the daytime portion and the overnight portion. This ineligibility as a dependent care expense holds even if the camp separately allocates the expenses for day time and overnight activities. The key criteria prohibiting such reimbursement appears to be the IRS view that this expense is not employment-related, and their refusal to entertain any attempts to allocate the overall expense into qualifying and nonqualifying categories.
Although food (such as a lunch program) may be reimbursable in certain circumstances, such as where the expense is incident to and inseparable from the cost of care for the qualifying individual, food expenses are typically not reimbursable. Where the food is charged to the parent as a separate, delineated expense, the IRS does not allow that expense to be reimbursed on a tax-free basis.
Unfortunately, warranties and protection plans are not eligible under the Health FSA, even if the device or service they cover is eligible. A common example of this is Eyewear Protection Plans offered by many optic shops. Though prescription eyeglasses, sunglasses, and contact lenses are all eligible under the Health FSA, the eyewear protection plan is not, since it does not provide a necessary medical service.
Some expenses, sometimes referred to as “dual-purpose,” are items or services that are often purchased for general good health or other purposes, but may sometimes be recommended by doctors to treat a specific medical condition. Some examples include weight loss treatments, massage therapy, and vitamins and nutritional supplements. If your doctor has recommended an item like this to treat a specific medical condition, you’ll need to submit a Letter of Medical Necessity from your provider in order to be reimbursed for the expense. We will need a letter from the physician stating that the item or service is recommended to treat the specific medical condition. The letter should be on the physician’s letterhead with clear reference to your case. It can be brief and does not have to go into detail or great substantiation. It simply must recommend the item or service to treat a specifically diagnosed condition. Or you may provide your doctor with this Letter of Medical Necessity form to complete. We’ll keep the letter on file for a year from the date written, and as expenses are incurred, you may submit provider receipts for the item or service along with your reimbursement claim as usual. A new letter of medical necessity will need to be submitted each year or each time the treatment changes.
Your employer may or may not offer the ProBenefits Debit Card as part of the benefit. Where the card may work will also vary based on your plan. Your employer should communicate to you whether the card is automatically included and any specific restrictions to your plan, for example: only works at retail pharmacies. If your plan does offer a Debit Card, you will automatically receive two Visa debit cards in your name. (If there is a secondary user, such as your spouse or partner, that user will simply sign the back of one of the cards.)
The fastest way to report your Debit Card as lost or stolen is by logging on to the web portal (https://my.probenefits.com) or the ProBenefits mobile app – look for Profile, then Banking/Cards or Manage Debit Cards. You may also call us at 888.722.8382 during regular business hours.
Top Five Benefits of Using the Debit Card:
You can do one of three things at this point:
While the ProBenefits Debit Card is available to be used with your Dependent Care FSA (if offered by your employer), some dependent care providers may not be equipped to accept debit cards, or may not have an eligible Merchant Category Code to allow the ProBenefits Debit Card to work there. Also, Dependent Care FSA reimbursement is limited to the amount you have contributed to date, so we encourage you to use the mobile app or web portal to check your available balance prior to swiping your ProBenefits Debit Card for dependent care.
Please remember that IRS regulations governing FSAs mandate that reimbursement is based on the date of service and that prepayments are not eligible to be reimbursed. Many dependent care providers require prepayment well in advance of services rendered. You may use your card for services that will take place in the current month, but please do not use your card for prepayment for care that will take place beyond the current month, or for registration fees for summer camps or other future services.
Your provider can credit the amount back to your ProBenefits Debit Card just as they would any other credit or debit card. Please note that it will take a few days for the credit to appear on your account. If the provider chooses to pay you back directly instead of applying a credit to your Debit Card, you may write a check to your employer for the overpayment, and they can let us know to credit the amount back to your account.
When documentation is requested for a ProBenefits Debit Card purchase, just log in to the web portal or the mobile app, and look in your Tasks for claims requiring receipts. Then you can simply upload the documentation right to the transaction, rather than completing an entire new claim. Please avoid submitting your ProBenefits Debit Card documentation as a new claim, as there’s a chance that it could be reimbursed rather than applied to the correct transaction.
Your Health FSA and your Dependent Care FSA are indeed two separate accounts, and the funds are not combined. However, when a Health FSA Debit Card transaction has been denied and needs to be repaid, the amount due can be offset from an eligible Dependent Care FSA claim. It is as if the plan reimbursed you for your Dependent Care claim and then you took that money and repaid your employer from those funds for the money due to the Health FSA. This offset actually reduces work for you, because it removes the middle step and returns your Debit Card to active status.
No, the Debit Card is just one option, not the only option. You always have the option to file a Reimbursement Claim as well. Just submit a claim on the web portal or mobile app with documentation, and we will reimburse you directly for your expenses. You definitely are not required to use the Debit Card. The Debit Card is simply an option for efficient and convenient reimbursement.
The Debit Card is cashless, but not paperless. IRS regulations require that all FSA transactions are substantiated (approved) as eligible expenses. Fortunately, many transactions (such as swipes for doctor visit co-pays or for prescription drugs or other eligible items at a pharmacy) will be automatically approved and will not require documentation. However, you will occasionally need to submit documentation to approve a card swipe and meet IRS requirements. The major benefit of the Debit Card is that it provides immediate payment so that you do not have to pay for eligible expenses out of your own pocket and then wait to be reimbursed.
If you submit a Reimbursement Claim while you have a ProBenefits Debit Card transaction in Denied status with repayment due, your reimbursement will automatically be used to repay the card transaction. This means that instead of paying out to you, your reimbursement will instead pay back your employer for the transaction requiring repayment. If you have valid documentation for the card transaction, you may still submit it, which will release your reimbursement to be paid to you on the next payment cycle.
If the Debit Card transaction was for an ineligible expense, you may leave the offset in place, as if you had written your employer a check to pay back the transaction.
The only information we receive about the charge when you use your ProBenefits Debit Card is the information contained in the documentation request email – location, date and amount.
While the charges must be from a valid provider of medical services (the card cannot be used at other locations), many medical, dental and vision service providers can also provide ineligible services. For example, dentists can provide teeth whitening, doctors can provide cosmetic services, and optometrists can sell non-prescription sunglasses.
Even if charges are for eligible services, they may still not fulfill all the requirements for reimbursement by the flexible spending account. For example, many times the final billing for services provided by a hospital in December is not sent out until well into the next year. If you use your Debit Card to pay for these charges which have service dates in the prior plan year, it may be an ineligible expenditure if your election is depleted for the prior year, you did not have an election during the prior year, or it is after the deadline for filing claims on the prior year’s account.
This is why the IRS requires that we have documentation for each charge that does not exactly match the amount and location of your company’s insurance copays which we have on file, or was not at a retail merchant with an IIAS (Inventory Information Approval System, which allows only eligible items to be purchased) in place.
Although most Debit Card transactions go through without a problem, there are several possible reasons your card might be declined.
Please contact ProBenefits if you have any questions!
Go to the web portal at https://my.probenefits.com.
If you have never logged in to my.probenefits.com before, click “Create your new username and password” under New User on the right. Enter the requested information and follow the steps to set up your account. (If you had an account on our old portal, you will have to set up new login information on our new portal.)
If you have logged in before but have forgotten your username or password, you can click the “Forgot Username?” or “Forgot Password?” link under Existing User to reset your login information.
To log in to the ProBenefits mobile app, you’ll need to set up your login on the web portal first, and then log into the app with that information.