How to Submit a Claim

  • 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 the name of the person and the name of the 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 Orthodontia Form. 
    • Over-the-counter items that may be claimed include contact lens solutions, hearing aid batteries, and testing supplies for diabetes. If the receipt does not readily identify the 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 (16 cents per mile for 2021, 18 cents per mile for 1/1/22 through 6/30/22, and 22 cents per mile for 7/1/22 through 12/31/22), a list must be submitted which includes dates, destinations, and the number of miles traveled.

    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 W-10 IRS form.

    Questions? Call the Flexible Benefits Office (585) 344-7616.  Please be aware that reimbursement checks are processed every two weeks.