How To File A Dependent Care FSA Claim

*Please Note:  Filing a claim is for requesting reimbursement on out-of-pocket expenses.*

Dependent Care FSA claims require substantiation.  Your provider may supply this documentation or you may use our DEPENDENT CARE RECEIPT FORM.  Please keep in mind that you may file for all eligible expenses that have been incurred from your plan year start date, up through the current month.  

If you are using an invoice from your provider, please make sure that it contains all of the information found on our Dependent Care Receipt form (see below).

DEPFSA Receipt Form

Filing Your Claims

Step 1:  From your account HOME page click the FILE A CLAIM button.

HOME page

Step 2:  Begin creating the reimbursement by selecting Dependent Care as the PAY FROM account and Me as the PAY TO account.  Click the NEXT button when you are ready to continue.

DEPFSA create reimbursement

Step 3:  UPLOAD VALID DOCUMENTATION and select Next to continue. Uploading your receipts is the ideal and most secure method for submitting documentation.  Alternate methods for submitting receipts include email, fax, mail, and drop-off (all alternate methods require the printable claim confirmation).

DEPFSA receipt documentation

Step 4:  Enter all required information (* indicates required field).  Once all of the required fields are completed, you may click NEXT to continue.

DEPFSA claim details

Step 5:  Submit the claim from the TRANSACTION SUMMARY page.  From the TRANSACTION SUMMARY you will have the option of adding another , removing, updating/editing, and submitting the claim(s).  You will be required to check the I HAVE READ, UNDERSTAND, AND AGREE TO THE TERMS AND CONDITIONS box before you can select SUBMIT.

transaction summary

Step 6:  Congratulations!  You have successfully filed you claim.  If you were unable to upload the receipt, you may select CLAIM CONFIRMATION FORM to use with alternate submission methods.  (See below for an example of the claim confirmation form, which must accompany all claim receipts submitted via fax, email, or mail.)

transaction confirmation

CLAIM CONFIRMATION FORM:  These documents are generated each time you file a claim.  Please include them as the cover page when faxing, emailing, or mailing in your receipts.  You do not need this document if you are uploading receipts through your secure online portal.

claim confirmation

Keep an eye on your account for important notifications.  Pending reimbursements will appear in the MESSAGE CENTER on your HOME PAGE.

*Once the claim is submitted, you will have the option to print the claim confirmation page.  

 **If you do not have the ability to upload your receipts, please use the printable claim confirmation page as the fax cover page or accompanying attachment to an email (the fax number/email address is located on the printable confirmation page).

***Processing on new claims for reimbursement typically takes 1 to 2 business days.