Employee Topics

Claims and Reimbursements

Unreimbursed Medical, Dental, and Vision Expenses

Does AdminUSA offer the Flex Debit Card?
Yes, the debit card is available through AdminUSA. The debit card provides the benefit of paying for your expenses directly from your FSA account, without upfront costs and reimbursements. You simply present your FSA Debit card to any pharmacist, doctor, dentist, department or grocery store which carry eligible FSA items and who accept MasterCard. The vendor will swipe your card and your FSA account is automatically debited for the funds. Keep in mind, however, you may be asked to substantiate your purchases to verify eligible expenses. If so, a copy of your receipt is usually sufficient. ALWAYS KEEP YOUR RECEIPTS.

Is the deductible on my major medical plan eligible for reimbursement?
Yes, however, you must submit the Explanation of Benefits Statement from your major medical carrier which indicates when the deductible was met and verifies that expenses were incurred during the plan year. We cannot accept a statement that only indicates that the deductible has been met.

How do I file a claim for expenses covered by insurance?
First, file the claim with your insurance carrier. After you receive an Explanation of Benefits Statement indicating which expenses are eligible for payment and which are not, submit a copy of the Explanation of Benefits statement to TPG Administrative Services. If you have an HMO, simply submit your co-pay receipts from the doctor or pharmacy. Copies of checks or credit card receipts are not valid receipts for unreimbursed medical expenses.

How do I file a claim for expenses not covered by insurance?
You may pay for your expense at point of sale with your FSA debit card, or, if you are requesting reimbursement for expenses already paid, such as dental, vision, or hearing, simply submit (fax or mail) a reimbursement request form along with a copy of the bill or receipt. The receipt should include the date of service, charges, and services provided.

Dependent Care Expenses

Are there certain circumstances under which an employee’s spouse is treated as if he or she is working even though the spouse is not employed?
Yes. If an employee’s spouse is a full-time student or is physically or mentally not capable of self-care, he or she is treated as if working. A spouse is a full-time student if he or she is enrolled at and attends a school for the number of hours or classes that the school considers full-time. The spouse must have been a student for some part of each of five calendar months during the year.

What expenditures are eligible for reimbursement under Dependent Care Flexible Spending Accounts?
Eligible expenses are defined as those that enable the participant and the participant’s spouse to work or to look for work. These include the following:

• Child care centers that care for six or more children, and that meet the IRS’s definition of a qualified day care center
• Caregivers for a disabled spouse or dependent who lives with the participant
• Babysitters
• Nursery schools
• Household expenses, provided that a portion of these expenses are incurred to ensure the qualifying dependent’s well-being and protection

A stipulation by the IRS is that the service provider must be over 18 years of age, and cannot be an individual for whom a personal tax exemption may be claimed.

What expenditures are prohibited for reimbursement under Dependent Care Flexible Spending Accounts?
Expenditures that are prohibited for reimbursement include the following:

• Babysitting for social events
• Educational expenses
• Charges for overnight camp
• Expenses that the participant will take as a child care tax credit on their income tax return

Is there a maximum amount of expense that may be reimbursed by a Dependent Care Flexible Spending Account?
Yes. The maximum annual contribution is $5,000 ($2,500 for married participants filing a separate income tax return), but no more than the lesser of the earned income of the employee or their spouse. If your spouse is a full-time student or incapacitated the maximum annual election is $2,400 for one child or $4,800 for two or more children.

Who is a qualifying dependent for purposes of a Dependent Care Flexible Spending Account?

• A dependent under the age of 13 who qualified as a dependent for income tax purposes
• A Spouse who is physically or mentally unable to care for himself or herself
• A dependent who is unable to care for himself or herself and who qualifies as a dependent for income tax purposes
• If the qualifying person is not under age 13, dependent care expenses incurred outside the home can be reimbursed only if the qualifying person regularly spends at least 8 hours a day in the employee’s household

Must an employee provide any information regarding the dependent care service provider on his income tax return?
Yes, the employee must provide the name, address, and taxpayer identification number of the person performing the services on the income tax return filed for the year in which the services were performed. If the service provider is a tax-exempt organization, its name and address must be provided on the employee’s tax return. If the preceding information is not provided, the tax exclusion can be maintained if the employee demonstrates to the IRS that the employee exercised due-diligence in trying to obtain the information. The employee may demonstrate the exercise of due-diligence by furnishing a copy of the service provider’s driver’s license or Social Security card.

Do I need to provide AdminUSA with any documentation?
Yes, if you participate in the dependent care account, please complete a Dependent Care Documentation form (enclosed). You must provide AdminUSA the name(s) of your child(ren), the name(s) of the provider(s) and taxpayer ID number. You must confirm that your spouse earns more than what you are having withheld in dependent care expenses.

How do I file a claim for dependent care expenses?
If your provider accepts Mastercard, you may use your FSA debit card for payment (and later submit paperwork to AdminUSA for substantiation) or you may complete a Dependent Care Expense Claim Form along with a receipt or statement from the dependent care provider. Claims may be mailed or faxed to (252) 265-5998. The receipt must show the dates of service and the name of the dependent for whom care was provided.