The instructions for filing claims for reimbursement from your FSA below are related to eligible expenses incurred in 2010. For 2009 claims, please contact Aetna at (800) 404-2386.
Whenever you have an eligible expense, you may use your HCFSA debit card (health care expenses only) or file a reimbursement request from the appropriate account. Claim forms are available at InfoBank > BenefitsWeb > Health & Welfare > Resource Materials > Documents & Forms.
If you file a claim, simply complete a claim form and submit it to:
ACS Spending Accounts
P.O. Box 6595236
San Antonio, Texas 78265-9536
You may also submit claim forms via fax to (877) 214-5051.
You may file for reimbursement as often as you choose. In general, you should receive payment within two weeks (claims are processed daily). You can have your tax-free reimbursement directly deposited into your bank account if you enrolled in direct deposit; otherwise, a check payable to you will be mailed to your home address.
You can submit requests for reimbursement of health care or dependent care services as they are incurred. You will be paid or reimbursed for only those services actually incurred during the calendar year. Expenses are incurred when the services are provided, not when you are billed for the services. An exception to this rule applies to orthodontia expenses which will allow for reimbursement of advance payments for orthodontia treatments prior to the actual incurral date of the service.
To ensure the prompt and accurate receipt of your reimbursement, follow the directions outlined below, according to whether the reimbursement is for health care or dependent care expenses.
If you have any questions (for example you want to ask about your account balance or the status of a reimbursement), you should contact Aetna directly. You can also access information regarding your account by logging in to InfoBank > BenefitsWeb > Health & Welfare > Flexible Spending Account or calling the Workplace Solutions Center at (888) 471-2271.
Filing HCFSA Claims
In most instances, you must first file a claim through your medical, dental or vision plan before you may file for reimbursement from your HCFSA. When you complete the HCFSA claim form, be sure to include your dates of service, services rendered, patient name, and patient responsibility, and return it to the address indicated on the claim form. You must also include the Explanation of Benefits (EOB) statement (when applicable) or the copies of the itemized bills or receipts related to the request.
Note that you can use your HCFSA debit card to pay for your share of the cost of eligible health care expenses at the time you receive services or treatment, in which case you will not need to file a claim. See below for more details on the debit card.
Health care claims will be reimbursed up to your annual contribution, less any previous reimbursements, regardless of the balance in your account at the time the claim is filed. At no time may your reimbursement exceed the total amount you have elected to be deposited for the year to your HCFSA, less any previous reimbursements.
Claim forms are available at InfoBank > BenefitsWeb > Health & Welfare > Resource Materials > Documents & Forms.
HCFSA Debit Card
If you participate in the HCFSA, you will receive a debit card . The debit card allows you to pay for out-of-pocket costs incurred at certain health care providers or pharmacies that have implemented certain standards required by the IRS, up to your plan year account election. The debit card is not accepted at all retail merchants. A list of debit card certified merchants, which is updated periodically, is available at InfoBank > BenefitsWeb > Health & Welfare > Flexible Spending Accounts. Contact the Workplace Solutions Center if you have specific questions.
Be sure to keep all your receipts. Due to IRS account administration guidelines, spending account transactions may require a copy of your receipt for documentation. Your receipt must show the amount, date of service, and nature of the expense. However, you do not need to submit receipts until you receive a written request to do so. All participants who have unsubstantiated transactions will receive an IRS Form 1099 MISC. This form shows the dollar amount of the unsubstantiated expenses to be reported to the IRS. You can also check to see whether any of your submitted expenses require further documentation on InfoBank > BenefitsWeb > Health & Welfare > Flexible Spending Account.
This debit card is intended for your convenience. The primary advantage of the card is that it allows you to access your spending account funds at the point of service without paying cash up front and waiting for reimbursement. You may choose not to use it and submit hard copy claim forms.
Filing DCFSA Claims
You must submit a claim form (along with proof of eligible expenses) for reimbursement of your dependent care expenses.
Each time you submit a claim form for reimbursement from your DCFSA, you must include both:
- Proof of payment.
- The provider’s name and taxpayer identification or Social Security number.
Dependent care claims will only be reimbursed up to the amount accumulated in your account at the time the claim is filed. If you submit a claim for more than the balance in your account, the amount not reimbursed will be paid once you have accumulated the amount required through your regular payroll contributions. For more information, please refer to your Summary Plan Description.
Claim forms are available at InfoBank > BenefitsWeb > Health & Welfare > Resource Materials > Documents & Forms.
Account Statements
To help in managing your account(s), you will receive a statement or Explanation of Payment (EOP) with each reimbursement, listing all claim transactions and current account balances for the month and year to date.
If your employment with ACS terminates, you may only file claims for health care expenses incurred before your termination date, unless you continue participation through COBRA. You have until March 31 each year to submit claims for any eligible expenses incurred during the previous coverage period.
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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.