How to Submit Documentation for a Receipt Request

The following instructions are for receipt requests (Flex Card transactions) only. Visit these links for information on Claim Submission and FSA FAQ

• Instructions for Submitting Documentation for Receipt Requests to myCafeteriaPlan

DO NOT use a traditional (paper) claim form. Doing so may result in the expense being tagged as a duplicate (ineligible) item.

1. Assemble all supporting documentation
   
   Canceled checks, credit card receipts, and sales slips are not acceptable as documentation for eligible expenses. Cash register and/or pharmacy receipts are acceptable only when they clearly identify a prescription number or over-the-counter (OTC) item. If an OTC item is not clearly identified, the receipt with the marked or highlighted item should be accompanied by the front box cover of that item. FOR ALL OTHER EXPENSES, supporting documentation must include:
   • Provider name and address
   • Patient/Dependent name
   • Date of Service
   • Description of Service
   • Amount charged
   An Explanation of Benefits (EOB) from an insurance company is acceptable and requires no further documentation.
   
   If a pharmacy receipt has been lost: request a filled-prescription history from the pharmacist.
   
   If a medical provider receipt has been lost: request an EOB from the insurance company. No other documentation is required.
2. Copy the supporting documentation and retain the originals.
   
   If receipts are smaller than 8.5x11 inches, copy or tape onto an 8.5x11 inch sheet of paper - do not staple receipts to claim form or each other!
3. Submit the documentation AND receipt request together.

• Submit Documentation for a Request Receipt

There are three ways to submit documentation to myCafeteriaPlan for Flex Care receipt requests: mail, fax, or e-mail. Follow the Instructions for Submitting Documentation and send directly to myCafeteriaPlan by:

• Mail
  myCafeteriaPlan - Claims
  432 East Pearl Street
  Miamisburg, OH 45342
• Fax
  Fax receiptrequest and copies of
  supporting documentation to
  937.865.6502
• E-mail
  Send receipt request and copies of
  supporting documentation as an
  attachment to
  claims@myCafeteriaPlan.com

Contact myCafeteriaPlan with any questions.