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Once you have paid for expenses that qualify for reimbursement from the FSA, you will need to complete a claim form provided by your employer and attach receipts or proof of payment with the form. The receipts must include specific information to prove that the payment was for qualified expenses.
You will need an Itemized Receipt from the day care provider. The receipt must reference the from/through date of service and be signed by the provider (or on the providers letterhead).
An itemized receipt with the five pieces of information is compliant. They need the date(s) of service, dependents name, providers name, type of service, and the total dollar amount paid for the services.
Dependent care FSA rules are subject to a use it or lose it requirement, which means participants must forfeit any unused funds remaining in their account at the end of the plan year and grace period (if a grace period is provided).
Required Documentation: Itemized statement from the provider with a clear description of service provided, name of the patient, date of service, the amount paid for service, and name of the provider. A signed statement indicating there is no insurance coverage for the service provided.
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Required Documentation: Itemized statement from the provider with a clear description of service provided, name of the patient, date of service, the amount paid for service, and name of the provider. A signed statement indicating there is no insurance coverage for the service provided.
Health Care FSA and Limited Expense Health Care FSA You must have a receipt or an explanation of benefits from your insurance carrier for each health care claim you submit against your account.
Remember, to be accepted for a claim, youll need one of the two accepted forms of paperwork: an itemized receipt, or an Explanation of Benefits (EOB) form (which is typically used for eligible medical services).

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