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FSA DEBIT CARD REQUEST FORM

FSA DEBIT CARD REQUEST FORM 2025

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The document is a request form for obtaining an FSA debit card from the FSA Department. It includes instructions for completing and submitting the form, details about transaction fees for card replacements and additional cards for dependents, and sections for providing personal information and authorizing the request. The form emphasizes the importance of submitting supporting documentation for transactions and outlines the consequences of using the card for ineligible expenses.

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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.

When should I receive my FSA card?

your plan year start date October 1st. For existing users, you can continue to use your same FSA card until it expires and a new one will be mailed to you. If you placed an order for a dependent or replacement card, it can take also 10 business days for your debit card to be mailed.

How do I get a debit card for FSA?

Your employer may offer an FSA or an HSA as a separate account to pay for eligible medical expenses. The accounts may be linked to a card. The rules on what type of spending is allowed for these accounts also apply to the use of the card.

Can my wife use my FSA card?

Its not uncommon for there to be more than one FSA in a single household. Since an FSA lets you apply tax-free dollars towards eligible medical expenses, it makes sense financially for everyone in the family to take advantage of the benefit if they can.

Do you get a separate card for FSA?

For new users, you should receive your FSA debit card in the mail by your plan year start date. If you placed an order for a dependent or replacement card, it can take 10 to 13 business days for your debit card to reach you. NOTE: Your card will arrive in a plain white envelope.

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