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Proper Documentation  Unacceptable Documentation

Reimbursement Guidelines

  1. To help avoid delays in reimbursement, dates of service must be clearly itemized with out-of-pocket expenses indicated on your documentation. Requests that are not itemized cannot be processed and will be returned to you.
  2. For the Flexible Spending Plan, service must be received during your plan year.
  3. For HRAs, you must be a participant in the plan year when requesting reimbursement and a participant in the plan year when services were received.
  4. Reimbursement is based on the date of service, not when the service was paid for.
  5. Itemize dependent care expenses by month for each dependent. (Not applicable to HRA.)
  6. For summer fun programs, indicate your expense for each month of service rather than a lump-sum total. (Not applicable to HRA.)

Deadline for Claims Submission

Be sure to submit your request well before the end of the 90-day grace period after the end of your plan year or after your termination date, whichever is earlier. This will help minimize the chances of forfeiting any unused balance in your account(s). Requests must be received in our office on the last day of the grace period. Claims received after the grace period will not be processed. (Not applicable to HRA.)

Proper Documentation for Reimbursement

To help ensure that we can process your request in a timely manner, here is a list of proper documentation for the most common out-of-pocket expenses:

Health/Dental/Vision Services
Each statement needs to show the name of the patient, name of the provider, date of service, description of service performed, and amount charged. A member report from the insurance carrier is the best form of documentation for these services. Expenses payable to the provider by the insurance company are not reimbursable.

Prescription Drugs
Each receipt needs to show the name of the patient, name of the provider, date of purchase, name of the drug, and amount paid. Some pharmacies do not automatically provide you with necessary receipts for reimbursement documentation. Be sure to ask your pharmacist for the appropriate receipt. Some prescribed medications, such as those for cosmetic purposes (e.g., weight loss and hair loss), are not reimbursable.

Massage/Shiatsu
According to IRS guidelines, a medical doctor must prescribe therapy services. Documentation must include: (1) medical condition being treated, (2) duration of treatment, and (3) frequency of treatment.

Contact Lens Solution and Other Over-the-Counter Items
You may submit register receipts, provided the receipt shows the name of the store, date of purchase, description of the item, and amount paid.

Orthodontics
Submit a copy of the contract or financial agreement from the orthodontist that includes the patient's name, description of services, initial deposit, and monthly payment. If the entire cost of the orthodontic services was paid at the beginning of the treatment, indicate the prorated amount based on the services incurred during your plan year. You will not be reimbursed for the entire amount. We will reimburse you for any initial payment or deposit required to start treatment.

Dependent Care
Submit a copy of the receipt or statement from your child-care provider. The statement needs to indicate the description of care, total cost, and duration of care. It should also show an itemized amount by month, per child. Any types of fees in addition to the actual cost of care (e.g., payments associated with registration, late payment, lunch, uniform, transportation) are not reimbursable. (Not applicable to HRA.)

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Unacceptable Documentation for Reimbursement

In accordance with IRS guidelines, BSHI cannot accept the following types of documentation for reimbursement:

  • Canceled check.
  • Credit card receipt or statement.
  • Cash register receipt (except for contact lens solution, other over-the-counter items, and parking fees for medical services).
  • Receipts that do not include the following information for store purchases: date of purchase, name of store, item purchased, and amount paid.
  • Statements that do not indicate all of the following for services received: name of patient, date(s) of service, name of provider, service provided, and amount charged.
  • Receipts or statements indicating "paid receipt" or "prior balance."
  • Receipts or statements for any non-qualifying expenses, even if prescribed by a medical doctor.

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Miscellaneous

For services or purchases not covered in these guidelines, BSHI will review the claims and documentation as specified by the IRS.