Rx
For prescription drugs, submit a copy of the tag (showing the cost, medication, date of service, and the patient name) attached to the prescription bag.
Office visits
For doctor office visits or other professional providers, submit a copy of the doctor’s receipt showing the date of service, the patient’s name, preprinted provider information, the treatment rendered, and the amount of the expense.
Insured expenses
Where you are responsible for a deductible or a percentage of the expense, before we can reimburse you, you must first submit these types of expenses to your insurance company. Your insurance company will then send you a summary of the claims you submitted indicating what amount, if any, they have paid. This is known as an “Explanation of Benefits” (EOB). We need a copy of this EOB in order to reimburse you.
Over-the-Counter Medicines
For over-the-counter medicines, submit a copy of the itemized cash register receipt showing the date, the item and the amount. If FlexBank cannot identify the item from the cash register receipt, the IRS requires you also submit the box top.
Orthodontia
For orthodontia, if your company’s plan limits reimbursement to a down payment with monthly installments, you will need to first submit a copy of the orthodontic agreement. You will then need to submit either a copy of the payment coupon or a statement showing what you owe for that month.
Other health care expenses
For expenses where The bill must show:
(a) pre-printed provider name & address
(b) the date of service and the amount of the expense
(c) the type of service rendered and the patient’s name
Balance due bills, visa receipts and cancelled checks are not acceptable because they don’t include all the information we need to make sure the expense is eligible.
Work Related Dependent Care
A receipt must accompany this type of withdrawal for expenses incurred, which should include:
(a) the provider’s name, address and Tax ID Number or Social Security Number
(b) the date of service and the amount of the expense
Where do I send my receipts?
You’ll send them to FlexBank.
Mobile Secure Upload: FlexBank.net
Scan/email: Claims@FlexBank.net
Mail: 1250 W Dorothy Lane, Dayton, OH 45409
Fax: 937.299.7992