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Payflex dependent care claim form

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Automatic Monthly Reimbursement for Orthodontia expenses. To establish automatic reimbursements check the box and include a copy of your ortho contract when submitting this form to PayFlex for the first time. Do not submit expenses previously paid for with your PayFlex Card. Not covered by insurance - For services or items submit an itemized statement from the provider showing the provider s name and address patient name date the service was provided a description of the service and the amount ...

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Got questions?

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

Can I use my PayFlex card for someone else?

Yes. You can seek payback for eligible expenses that you, your spouse and eligible tax dependents have during the plan year. This is true even if you don't cover your spouse and dependents on your health plan.

Is PayFlex use it or lose it?

View the IRS contribution limits and a list of common eligible expense items on the PayFlex member website. FSAs have a use-it-or-lose-it rule. This means you'll lose any unused funds at the end of the plan year. Check your plan details to confirm how it works.

How do I get reimbursed for PayFlex?

If not offered, you can easily be reimbursed from PayFlex for any money you spend out of pocket on qualified expenses, by taking a picture of your receipt and uploading through our mobile app or member website. If your plan includes a PayFlex Card, you'll use that to register your account on the PayFlex member website.

Why can't I log into my PayFlex account?

For security reasons, we locked your online account. To resolve, call us at 1-844-PAYFLEX (TTY:711). You've entered an incorrect username or password. Please try again.

How long does PayFlex withdrawal take?

After you link a bank account to your HSA, we'll send a deposit of less than $1.00 (and matching withdrawal) to your bank account. This process can take up to two business days, not including Saturdays, Sundays or holidays.

can i withdraw money from my payflex card

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How do I submit a claim to PayFlex?

Go to payflex.com and click Documents & Forms at the top of the page. Select Administrative Forms and click Flexible Spending Account Claim Form. Complete all fields of the form. Sign and date the form. \u2022 Mail or fax your completed claim form and supporting documentation to PayFlex.

How do I withdraw money from my PayFlex HSA?

Click on the Financial Center. Note: If you have multiple accounts, select your Health Savings Account from the drop-down menu at the top of the page. Click on Make an HSA Withdrawal. This lets you withdraw funds from your HSA and deposit them into your linked bank account.

Can I withdraw cash from my PayFlex card?

No. The card won't work at an ATM. And you can't get cash back with your card. You can only use the card to pay for eligible expenses.

How do I submit a claim to PayFlex?

How do I contact PayFlex?

PayFlex® Advocate. 1-844-PAYFLEX. (1-844-729-3539)(TTY: 711) Monday - Friday, 7:00 am - 7:00 pm (CT) Saturday, 9:00 am - 2:00 pm (CT) content.

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Got questions?

Can I use my PayFlex card for someone else?

Is PayFlex use it or lose it?

How do I get reimbursed for PayFlex?

Why can't I log into my PayFlex account?

How long does PayFlex withdrawal take?

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How do I submit a claim to PayFlex?

How do I withdraw money from my PayFlex HSA?

Can I withdraw cash from my PayFlex card?

How do I submit a claim to PayFlex?

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