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Reminders Is your Employee Identification number EIN included on the form Your EIN is at the top of your biweekly earnings statement. A cancelled check is not adequate documentation. Small receipts should be taped to a standard 8. 5 x 11 sheet of paper and must be legible when scanned. Part 2 - HEALTH CARE EXPENSES Medical Dental Vision and Hearing Expenses For expenses partially covered by your medical dental or vision insurance plan you must submit your Explanation of Benefits EOB statement ...

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does FSA apply to dependents?

You can use funds in your FSA to pay for certain medical and dental expenses for you, your spouse if youre married, and your dependents. You can spend FSA funds to pay deductibles and copayments, but not for insurance premiums.

How do I make an FSA claim?

How to File a FSA Claim Complete a Request for Reimbursement Form and attach the proper documentation for the claim OR upload your claim via our Mobile App or your Online Account. You may submit your Request for Reimbursement Form by mail or by email. Please make sure you submit the proper documentation with the claim.

How do I submit a dependent to FSA?

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.

How do I submit a dependent care FSA claim to PayFlex?

During the plan year, youll pay for your eligible dependent care expenses out of pocket. Once your dependent receives the care, you can submit a claim to pay yourself back from your DCFSA. You can do this online, through the PayFlex Mobile app, or complete a paper claim and fax or mail it to us.

How do I report dependent care to FSA?

Box 10 on your W-2 form should indicate the total annual amount of your Dependent Care FSA deductions. When completing your tax return, you will need to attach a Child and Dependent Care Expenses form (Form 2441 for a 1040 return; Schedule A for a 1040A return). You should contact a tax preparer for more details.

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How do I add dependent care to my FSA?

Your FSA contributions must be claimed on your federal tax returns by attaching Form 2441, Child and Dependent Care Expenses. You will need to supply information about the expenses as well as information about the dependent and the care provider. You cannot change your contribution amounts on a whim.

How do you get your FSA money?

There are typically three ways to access your FSA money. You can use a smart debit card connected to your account, pay providers directly through your online portal, or submit receipts for reimbursement. Check with your employer to find out which options they offer.

What documentation is needed for FSA reimbursement?

Q: What documentation is required to verify the eligibility of my FSA expense? documentation containing 1) date of service, 2) type of service, 3) charged amount, 4) name of the provider, and 5) any insurance paid on the expense, if applicable, for each claim.

Can I reimburse myself from FSA account?

Whose expenses can I claim under my FSA? You can use your FSA to pay for eligible expenses incurred by any of the following individuals: Yourself.

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Does FSA apply to dependents?

How do I make an FSA claim?

How do I submit a dependent to FSA?

How do I submit a dependent care FSA claim to PayFlex?

How do I report dependent care to FSA?

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How do I add dependent care to my FSA?

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What documentation is needed for FSA reimbursement?

Can I reimburse myself from FSA account?

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