FAQ

FSAs, HSAs, and HRAs all have documentation requirements for using those funds. Generally, documentation will need to show:

• the date of service,
• the services that were rendered,
• and the amount that you owe for those services after insurance and other discounts.

For FSAs, HSAs, and some HRAs, a detailed provider receipt or itemized cash register receipt is usually sufficient, if it contains all the required information listed above. For some HRAs, an Explanation of Benefits (EOB) from your insurance company is required. (EOBs are usually great documentation, no matter which type of benefit you have!)

Watch out for credit card slips that only show date of payment and amount – those are missing important information like date of service (the service date is the important date, and sometimes the date you pay is not the same day that the service is rendered), what service was provided, and details about the amount paid (for example, if a provider makes you pre-pay for an expense, sometimes they end up owing you money back after insurance adjustments – so the amount you initially paid may not be the amount that your plan can reimburse).

For FSA and HRA reimbursement claims, you will need to submit documentation along with your claim; and for some benefits debit card purchases, you will need to submit supporting documentation following the transaction. But even in situations where you don’t need to submit documentation to ProBenefits, like a benefits debit card swipe that is automatically approved or an HSA withdrawal, it’s important that you keep valid documentation on file, in case of audit by the IRS.

It will make using your benefits much easier if you make a habit of asking for good receipts from your providers at the time of service (and keeping your EOBs when you receive them in the mail or online), and start a file to keep track of them in case they’re needed.

Tip: Dependent Care claims require documentation too, and sometimes dependent care providers don’t provide adequate receipts as part of their general practices. In this case, you can have them complete our Dependent Care Receipt Form to get the documentation you need.

Collection and storage of umbilical cord blood as a precaution to treat a disease or condition that might possibly develop in the future, in case it is needed, is not considered medical care, and therefore is not a Health FSA or HSA eligible expense. But collection and storage of cord blood might qualify if there is an existing or imminently probable disease that the umbilical cord blood is intended to treat. For example, the cost of storing cord blood where a newborn has a birth defect and where the cord blood would be needed in the near future, or in advance of a scheduled surgery for use in a possible transfusion, might qualify. A letter of medical necessity from a doctor recommending short-term storage of the cord blood for use in treating a specific medical condition would be required. Before making an election based on this expense, please contact us to ensure the eligibility of your particular situation.

A Dependent Care FSA is used to set aside pre-tax funds to pay for eligible daycare or childcare expenses for your dependents so you and your spouse (if applicable) can work, look for work, or attend school full-time.

Covered expenses must be for:
• Dependent children age 12 and under; or
• A person of any age whom you claim as a dependent on your taxes and who is mentally or physically incapable of caring for himself or herself.

What’s eligible? Eligible expenses include childcare (nursery, preschool or private sitter), before and after school care, and day camps.

What’s not? Ineligible expenses include kindergarten tuition, overnight camps and expenses paid to a tax dependent.

It’s a common misconception that a Dependent Care FSA can be used for medical expenses for your dependents, or for other expenses such as diapers and baby wipes. This is incorrect, however – a Dependent Care FSA only covers the expense of someone else caring for your child or dependent while you (and your spouse, if you have one) are working, looking for work, or attending school full-time.

Updated 3/29/21: The IRS has issued guidance in Announcement 2021-7 that personal protective equipment (PPE) that prevents the spread of COVID-19 is treated as an expense incurred for medical care under 213(d). This means that PPE can now be reimbursed through a Health FSA, HSA, and 213(d) HRA (HRAs that only reimburse deductible or coinsurance/out-of-pocket expenses are unaffected by this change).

The PPE can be for the participant as well as the participant’s spouse and dependents.

PPE includes:

• Masks
• Hand sanitizer
• Sanitizing wipes
• Disposable gloves
• Any other equipment for the primary purpose of preventing the spread of COVID

This guidance is effective retroactively back to 1/1/20 so any PPE expenses incurred on/after 1/1/20 are eligible. ProBenefits had previously determined in April 2020 that masks were eligible items, and we have reimbursed claims for masks accordingly since then. We have also reimbursed claims for disposable gloves with accompanying letter of medical necessity; now the letter of necessity will no longer be required. Claims for PPE items that were previously denied can be resubmitted for open plan years.

Keep in mind this change applies to protective equipment only. Vitamins and supplements taken as a preventive regimen will still require a letter of medical necessity to be eligible for reimbursement.

Please note that it may take merchants some time to update their list of eligible expenses, so your ProBenefits debit card may not work for these expenses right away. But you may submit a reimbursement claim for these items at any time.

There are certain qualifying events that will allow you to change your dependent care election during the plan year. Some of these include:

• Change in employment status or change in employment location (e.g., move from full-time to part-time or move to working remotely)
• Loss of eligibility (e.g., reduction of hours)
• Commencement of FMLA and return to work following FMLA
• Daycare provider is closed/opens

If you have questions about a particular qualifying event, please contact us. To make a change in your election based on one of the above events, please contact your employer.

Because your benefit account data is considered protected health information and is protected by HIPAA (a federal privacy and security law), you will need to complete and return an individual Authorization for Disclosure of Protected Health Information form to allow your spouse or other designated recipient to receive your protected health information when contacting ProBenefits about your account.

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 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 use the same username and password that you use on the web portal. If you’ve never logged in to the web portal or the app before, tap “New User? Set up your account” at the bottom of the app login screen to get started.

View a step-by-step guide with screenshots in PDF format.

Use the links below, or just search for ProBenefits on the App Store or Google Play, and download the ProBenefits app with the yellow apple icon.

Apple | Android

If you already have a login from the web portal, you’ll use the same username and password to log in to the app. If you’ve never logged in to the web portal or the app before, tap “New User? Set up your account” at the bottom of the app login screen to get started.

Although most Debit Card transactions go through without a problem, there are several possible reasons your card might be declined.

1. Do you have any overdue documentation requests or denied card claims? If so, your card may be blocked until these are cleared up. You can login to your account at  https://my.probenefits.com or on the ProBenefits mobile app to see if you have any Debit Card transactions that require repayment.
2. Are you out of funds for the plan year? Login to your account at  https://my.probenefits.com or on the ProBenefits mobile app to see how much money you have left in your account for the year.
3. Did you try to swipe your card at a pharmacy or retail merchant? For most plans, the Debit Card will only work at a pharmacy or retail merchant if it has an IIAS (Inventory Information Approval System) in place, so if your pharmacy or retailer does not have this system, you will need to file a reimbursement claim with your out-of-pocket receipt to get reimbursed instead of using your card. However, with over 35,000 national, regional and local retail locations participating in IIAS, you should be able to use your card successfully at most locations. See a list of participating retailers here, or search for your favorite merchant here.
4. If you were using your card at an IIAS-participating retailer, it’s possible that the items you were attempting to purchase with your Debit Card are not actually eligible, which would prevent the card from being used to purchase them. For example, multivitamins and supplements are often assumed to be eligible but in reality are not. View an example list of eligible expenses here.

See this helpful flyer for tips on using your debit card, and please contact ProBenefits if you have any questions!

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.

See this helpful flyer for tips on using your debit card.

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 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.

See this helpful flyer for tips on using your debit card.

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.

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 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.

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.

See this helpful flyer for tips on using your debit card.

You can do one of three things at this point:

1. Offset this charge by submitting a reimbursement claim with documentation for another FSA-eligible expense that was not paid for with your Debit Card and has not otherwise been submitted for reimbursement. Please note the transaction you’d like to offset in the Description section of your claim.
2. Repay your employer by logging on to https://my.probenefits.com and making an online payment. In order to do this, the charge must be denied, and the repayment option will show up in the Tasks section on your home page. Please let us know if you would like to choose this option but the charge is not denied yet, and we can deny it for you.
3. Repay your employer by writing a personal check payable to your employer. If you repay this amount to your employer, please have your HR department contact your ProBenefits Plan Administrator to have this resolved on your account. (Note that some employers do not offer this option.)

See this helpful flyer for tips on using your debit card.

Top Five Benefits of Using the Debit Card:

1. Cashless FSA Transactions: The ProBenefits Debit Card provides instant access to FSA funds, reducing out-of-pocket expenditures.
2. Less Paperwork to Submit: Charges are automatically approved (“auto-adjudicated”) at many locations where the card is accepted, so in many cases you will only need to save your receipts instead of submitting them to ProBenefits.
3. Online Account Access: See personal account information including your available balance and transaction history.
4. Free Cards: There is no fee for cards for you and your spouse or dependent.
5. Flexibility: You can still file reimbursement claims if you forget your card or choose not to use it. 

See this helpful flyer for tips on using your debit card.

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.

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.)

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 massage therapy, some vitamins and nutritional supplements, and weight loss treatments (note that food and food replacements are not eligible, even with a doctor’s recommendation). 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. Before making an election based on an expense that requires a letter of medical necessity, please contact us to ensure the eligibility of the expense in question, as the changes allowed to FSA elections are very limited.

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.

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.

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.

Once care is provided, most registration fees are eligible if they are required for care to be provided.

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. Before making an election based on this expense, please contact us to ensure the eligibility of your particular situation.

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. Before making an election based on this expense, please contact us to ensure the eligibility of your particular situation.

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.

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.

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.

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:

2019 Medical Mileage Worksheet
2020 Medical Mileage Worksheet
2021 Medical Mileage Worksheet
2022 Medical Mileage Worksheet

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.

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.

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.

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.

IRS Publication 502 (2006), “Medical and Dental Expenses”, states in pertinent part:

Special Education

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:

• Teaching Braille to a visually impaired person,
• Teaching lip reading to a hearing-impaired person, or
• Giving remedial language training to correct a condition caused by a birth defect.

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.

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.

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.

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.

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. Before making an election based on this expense, please contact us to ensure the eligibility of your particular situation.

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.

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.

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).

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.

See our blog post for more detail.

Previously, over-the-counter (OTC) drugs and medicines required a prescription for reimbursement, but that changed on March 27, 2020, and a prescription is no longer required. Learn more in our blog post.

Participants should be aware of the most common claims problems that delay or prevent FSA reimbursements:

1. No Date of Service – We are often given the date of payment or the statement date, but we must have the date of service.
2. Invalid Documentation – A canceled check or credit/debit card payment receipt does not properly validate a claim.  A provider statement or an EOB from the insurance company must be submitted.
3. Illegible documentation – Make sure the documentation you upload with your claim is clear and doesn’t cut off any important data, like provider, date of service, type of service, or expense amount.
4. Ineligible Dates of Service – Remember that the date the expense was incurred must be while you were a plan participant, and in a current plan year.

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!

Sometimes, an FSA reimbursement request must be denied. Common reasons include:

• Improper provider receipt to document expenses (Charge receipts, debit/credit card slips and canceled checks cannot be accepted to document your claim. They only indicate a payment date, which is not necessarily the date the service was rendered, nor do they indicate type of service rendered.).
• Expense is ineligible (examples: teeth whitening, eyewear protection plans, cosmetic surgery).
• Expense was not incurred during the current plan year.
• The provider receipt does not indicate the actual date the service was incurred (for example, receipt just shows “prior balance”).

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.

To be eligible for FSA reimbursement, an expense must meet the following criteria:

• Purchase was for an eligible product or service per IRS rules;
• Product or service was purchased for an eligible person (the participant or eligible dependent);
• Expense was incurred during the current plan year;
• Expense is properly documented by a provider receipt. Canceled checks or credit card slips are not acceptable because they only show the purchase date and amount, and other necessary information cannot be determined, e.g. service date, type of service rendered.

ProBenefits also checks to determine if :

• Adequate funds remain in the participant’s FSA account. Often, towards year end, the FSA account has been fully spent.  Once the annual election has been met, submitted claims will be designated as “over election.”
• The claim is properly completed. The properly completed claim provides information regarding the amount being claimed (not always equal to the attached receipt amount) and certifies, by submission, that:

“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.”

To answer this question, it helps to know the basics of how Direct Deposit works:

1. ProBenefits processes the payments and sends the file to our bank.
2. Our bank verifies the file, then forwards it to the Federal Reserve Bank in Richmond, Virginia.
3. The Federal Reserve processes the file and instructs your personal bank to credit your account for the payment amount.  At the same time the money is credited to your account, it is debited from your Employer’s bank account.

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.

Want to add or change your direct deposit information? The easiest way is to log on to your account on the web portal (go to Accounts, then Banking/Cards under Profile) or mobile app (go to Profile, then Manage Bank Accounts). If you are unable to do so, you may complete and return this 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.

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 a claim form here.