How to File an FSA Reimbursement Claim
1) Make sure your expenses are eligible
2) Collect proper documentation
Examples are itemized receipts, insurance company Explanations of Benefits (EOBs), or provider account statements.
Note: Due to IRS regulations, we cannot accept cancelled checks, bank statements or non-itemized credit/debit card slips.
- Verify that each document shows Date of Service, Type of Expense, Provider Name and Amount Incurred.
Note: Expense does not actually have to have been paid.
- Make sure documents are legible.
Don't use a highlighter on your documents - highlighted areas often appear black when faxed.
If you have a very light receipt, try making a darker copy and then faxing the copy.
- Keep the dependent care documents separated from the medical.
3) Complete a claim form
- Make sure you have a current Claim Form.
- Write in your name, company name and Social Security number.
- On the "From Date" line, enter earliest date of service; on the "To Date" line, enter latest date of service.
If the dates of service are in two different plan years, please complete a separate form for each plan year.
- Tally medical and dependent care amounts on appropriate lines.
Dependent care is a separate FSA account to pay for child care expenses - all medical expenses for you and your dependents should be entered in the Medical/Dental/Vision Care section.
- Sign the form!
The participant's signature is required - spouse or dependent signatures cannot be accepted.
4) Submit your claim to ProBenefits via fax, email or regular mail
To submit your claim via toll-free fax:
- Fax claim form and documentation to Fax-a-Claim at 866-FAX-FLEX (that's 866-329-3539)
- Please send both Direct Deposit and Check by Mail claims to this fax number. The method of reimbursement for your claim will be determined by the information on file in your account. To view or change your reimbursement information, please log in to your account at online.probenefits.com.
To submit your claim by email:
- Make a clear scan of your signed claim form and supporting documentation.
- Save in PDF format (other file formats may not be accepted, or may result in processing delays)
- Email to firstname.lastname@example.org
To submit your claim by mail:
- Make a good, clear copy of your claim form and all documentation to send to ProBenefits, and keep your originals on file in case of lost mail.
- Mail to:
2640 Reynolda Road
Winston-Salem, NC 27106-3817
5) Check your email and/or check the status of your claim online
Your claim will be processed within 1-2 business days after receipt by ProBenefits. The morning after your claim is processed, you will receive an emailed confirmation notifying you that we have entered your claim and letting you know of any problems. You can also check online.probenefits.com to see an image of your claim, with any problem areas noted.
You can log in to your account at online.probenefits.com to make sure we have the correct email address to send your confirmation. If we have no email address on file, you will receive a letter by mail if there are any problems with your claim. You will still be able to view your claim status online, even if we don't have an email address.
6) Watch for your reimbursement
Reimbursement of approved claim amounts will come either by direct deposit to your bank account or as a check through the mail from ProBenefits or directly from your employer. Ask your employer or contact ProBenefits to find out which methods your plan allows.
If your employer offers direct deposit reimbursement, you can sign up for it at any time.
Questions? Please call us at (336) 761-1850 or (888) 722-8382, or email us at email@example.com