FLEXIBLE BENEFITS PROGRAM

How To Submit Claims

MEDICAL REIMBURSEMENT PLAN

• Each receipt/bill should clearly show the date of service and type of service rendered.  (Cancelled checks or credit card receipts alone are not acceptable).

• Each prescription receipt must include name of person and name of drug. (Cash register receipts alone are not acceptable).

• All dates of service/treatment must be within the dates of the Plan Year.

• Participants have access to the full amount set aside from the first day of the Plan Year.

• If you are making claims for orthodontics, a form from the doctor must be on file.  Call the Flex Office for the form.

• Over the counter items that may be claimed include pain relievers, allergy and cold remedies, antacids, contact lens solution, hearing aid batteries and testing supplies for diabetes.  If receipt does not readily identify item, box tops need to be submitted.  Products such as vitamins or dietary supplements that are “merely beneficial to general health” may not be claimed.

• To receive compensation for mileage (call Flexible Benefits Office for the current mileage reimbursement rate), a list must be submitted which includes dates, destinations and miles.

DEPENDENT CARE REIMBURSEMENT PLAN

• The dates of service and the child's name must be on each receipt.

• Expenses for daycare are reimbursed only after service has taken place.

• Participants have access only to the amount they have contributed to date.

• A W-10 IRS form completed by the dependent care provider must be on file.  Call the Flex Office for the form.

Questions?  Call the Flexible Benefits Office
(585) 344-7616

**Reimbursement checks are processed once every two weeks**