How to Submit a Claim for Reimbursement
The following forms and instructions are for traditional (paper) claims only. Visit these links for information on Flex Card and Documentation Requests.
Instructions for Submitting a Claim to myCafeteriaPlan
Verify the expense is eligible for reimbursement.
Gather your valid documentation.
- Canceled checks and credit card receipts are not valid documentation. Valid documentation should include:
- Provider Name & Address
- Patient Name
- Date of Service
- Service Description
- Amount Charged
- An Explanation of Benefits (EOB) from an insurance company is valid documentation.
- For Daycare Expenses Only
- In addition to the information required for valid documentation, daycare documentation must include your provider’s Taxpayer Identification Number (TIN) or Social Security Number (SSN).
- If your provider signs the claim form, no other documentation is needed (the claim form will serve as your documentation).
- If you are married, both you and your spouse must be employed to qualify for the daycare pre-tax benefit.
Copy your documentation and keep originals for your personal tax records.
Complete a claim form if you plan to mail or fax your documentation.
- Log into your account to download a claim form from the Tools and Support tab.
- Be sure to sign your claim form.
- A claim form is not needed if you submit your claim online or through the mobile app.
Submit your claim one of four ways:
- myCafeteriaPlan On-The-Go AppTM: Download from the App store, enter passcode, select File a Claim, and follow prompts.
- Online: Log into your account and click the “File a Claim” link on the left-hand menu.
- Fax: (937) 865-6502
- Mail: myCafeteriaPlan, 432 East Pearl Street, Miamisburg, OH 45342
Submitting documentation for a flex card transaction?
- Do not use a claim form or file a new claim through the mobile app or online
- Be sure you are submitting valid documentation
- Submit documentation through the mobile app, through your online account, via fax, or in the mail