The IRS has specific rules for Limited Purpose Flexible Spending Accounts and you must always verify expenses by submitting receipts and documentation.

Read on to find out specifics on submitting LPFSA claims, or jump to a section with these links:

  1. How do I submit an LPFSA claim?

  2. What documentation is required for LPFSA reimbursements?

How do I submit an LPFSA claim? 

To submit a Limited Purpose Flexible Spending Account (LPFSA) claim, log into your account and submit receipts and documentation for all eligible dental and vision care expenses. 

Here’s how to submit a Pay Me Back claim.

  1. Log into your account.

  2. Click Reimburse Me.

  3. Enter payment information and select Submit Claim.

  4. Upload digital copies of your receipts and documentation.

Here's how to submit a Pay My Provider claim.

  1. Log into your account.

  2. Click Pay Provider.

  3. Enter payment information and select Submit Claim.

  4. Upload digital copies of your receipts and documentation.

Note: You won’t be able to cancel or delete a claim once it has been submitted for reimbursement in your account. If an error is made in a submission, you'll need to submit a new claim with the correct information and documentation.

In your account you can: 

  • Check account balances 

  • Submit claims and view claims status 

  • Look up eligible expenses 

  • Upload receipts to verify card transactions 

  • Select your reimbursement methods (by check or direct deposit) 

  • Choose to receive account alerts by email or text

What documentation is required for LPFSA reimbursements? 

The IRS has specific rules for LPFSAs and you must always verify expenses with receipts.

Save receipts for each eligible expense you submit for reimbursement under your Health Savings Account (HSA)-Compatible or Limited Purpose Flexible Spending Account (LPFSA). Make sure receipts and documentation include the following five pieces of information: 

  1. Patient's Name. The name of the person who received the service or for whom the item was purchased. For retail store purchases, this information may be excluded. 

  2. Provider's Name. The provider that delivered the service or the merchant where the item was purchased. 

  3. Date of Service. The date when services were provided or the item was purchased. 

  4. Type of Service. A detailed description of the service provided or item purchased. A bag tag is sufficient for prescriptions. 

  5. Cost. The amount paid for the service or product and/or the portion that is not reimbursed through your insurance carrier. 

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