Flexible Spending Account (FSA) Year-end Reminder
Grace Period
Your Flexible Spending Account (FSA) plan year is ending soon. We encourage you to check your account balance on
your PayFlex member website and submit your eligible claims as soon as possible.
Also, your employer has adopted the grace period which allows you an additional 2 ½ months to spend your FSA dollars.
Just be sure to submit your claims by the end of your plans run out period.
Below are some tips on submitting claims, receiving claim payments faster and how to stay up to date on your account
activity.
When you submit a health care claim, be sure to include:
 An Explanation of Benefits (EOB) statement from your insurance company, OR
 An itemized statement/detailed receipt showing:
o Merchant or provider name
o Patient name (if applicable)
o Date of service
o Description of service or product
o Amount you were required to pay
For dependent care claims, your documentation needs to
include:
o Dependent name and age
o Provider name
o Dates of service
o Service description
o Amount of service
You have 3 ways to submit a claim:
1
Submit a claim online
2
Use the PayFlex Mobile™ app
Once you log in to your PayFlex member website, select File a Spending Account Claim under Quick Links.
 Enter your claim information. To add additional claims, select Add Another Claim.
 Once you enter in all of your claims, click Next.
 Confirm all expense details and click Next. To make changes, click Previous.
 To include supporting documentation, select Fax or Upload.
o To “Fax,” click on Create Coversheet. Print and sign the form. Fax it with your documentation to
the number on the coversheet. When you sign the fax coversheet, you certify that your claim is
for an eligible expense.
o To “Upload,” use the Browse button. Select your documentation from your computer. To add
additional documents, click on Add Additional Document. Note: Each document must be
uploaded in PDF format.
 Check the signature box to sign your claim and confirm your submission is for an eligible
expense.
 Click Submit.
Download the free* PayFlex Mobile app from your mobile app store. Log in to the app with the same username
and password you use for the website.
 From the Financial Center, select File Claim.
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Select your employer (if applicable) and your expense type.
In the Expense Start Date field, enter the date of service or purchase.
Enter the amount that you paid for the product or service. For a dependent care expense, enter the
expense end date and your dependent’s name.
To attach a document, select the Add Photo image. Then select Review Claim.
After you review your claim, select Submit. If you need to make a change, select Cancel.
Select I Agree to submit your claim. Select Go Back to make a change.
Send a paper claim form to PayFlex
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Go to your PayFlex member website and visit the Resource Center.
Select Administrative Forms and click Flexible Spending Account Claim Form.
Print the form, and complete all fields. Then, sign and date.
Mail or fax your completed claim form and supporting documentation directly to PayFlex.
Get your claim payments faster with direct deposit
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Log in to your PayFlex member website. From My Dashboard, click on My Accounts and Services on the left side
of the screen.
Click on Enroll in Direct Deposit.
Select your employer (if applicable) and bank account type. Enter your account number, routing number and
bank name. Click Next.
Review your account information. If the information is correct, click Confirm. If you need to make a change, click
Previous.
Stay connected to your PayFlex account
To help you stay up to date on your account activity, sign up to receive account notifications.
 Log in to your PayFlex member website.
 From My Dashboard, select My Settings.
 Select like notifications link. Enter your e-mail address twice.
 Select the notification(s) you wish to receive. Then click Submit.
Note: The Explanation of Payment notification will let you know when your claim is approved or denied for payment.
Questions?
Visit your PayFlex member website and click Contact Us. We’re here to help Monday – Friday, 7 a.m. – 7 p.m. CT and
Saturday 9 a.m. – 2 p.m. CT.
*Standard text messaging and other rates from your wireless carrier still apply.
PayFlex Systems USA, Inc.
This material is for informational purposes only. Information is believed to be accurate as of the production date; however, it is
subject to change. For more information about PayFlex, go to www.PayFlex.com.
©2014 PayFlex Systems USA, Inc.
69.03.563.1 (10/14)