What makes an FSA claim valid?

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.”