Flexible Spending Account (FSA) Reimbursement 2025

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How to use or fill out Flexible Spending Account (FSA) Reimbursement

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information in the designated fields, including your name, address, and FSA account number.
  3. Next, provide details about the OTC medicine for which you are seeking reimbursement. Include the product name, purchase date, and amount paid.
  4. Attach a copy of your physician’s prescription. Ensure it is dated before the purchase date and includes any necessary refills if applicable.
  5. If required, upload a copy of the product's label or packaging as proof of purchase.
  6. Review all entered information for accuracy before submitting your claim for reimbursement.

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With an FSA, you submit a claim to the FSA (through your employer) with proof of the medical expense and a statement that it hasnt been covered by your plan. Then, youll get reimbursed for your costs.
FSA Overview A Flexible Spending Account is an employee benefit that allows you to set aside money from your paycheck, pre-tax, to pay for healthcare and dependent care expenses. Unlike a Health Savings Account (HSA), an FSA is not administered by your health insurance.
You can use the funds from your FSA either with an FSA debit card provided by your employer, or by submitting paper receipts for reimbursement of FSA eligible expenses. You can use your FSA debit card at any approved pharmacy or store that accept these special cards.
Cons of a Flexible Spending Account Use-It-Or-Lose-It Rule: Unused FSA funds are forfeited unless your employer offers a grace period or carryover option. Eligibility Restrictions: FSAs only cover qualifying medical expenses, dental and vision costs, and dependent care expenses.
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