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FSA CARD ACTION |
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TYPE OF VENDOR OR TYPE OF SERVICE |
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HELPFUL HINTS |
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No Substantiation Required
The FSA Card will work without further action on your part! |
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| HealthCare Providers with Copays: |
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Hospitals
Pharmacy
Physicians Office
Vision Care Providers
Dentists
Urgent Care
Outpatient Surgery Centers |
Prescriptions & Over-the-Counter items can be purchased at retailers like these: |
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Coinsurance is where the employee pays a percentage versus a flat copay. These may require you to submit receipts. It's important that you keep all of your receipts.
You will receive a letter if receipts are required. |
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A&P
Albertson's
Bigg's
Cubs
CVS
Giant Eagle
Giant Foods
Kroger |
Meijer
Medco
Sam's Club
Safeway
Shop & Save
Target
Walgreen's
Wal-Mart |
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Recurring Expenses: by indicating expenses are recurring in exact equal amounts for the exact same provider on the FSA Claim Form, you will not need to continue to send in receipts and claim forms.
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Examples include Dependent Care and monthly visits to certain types of healthcare providers. |
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May require receipts |
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Reimbursement for Deductibles
Reimbursement for Coinsurance (%)
Reimbursement for Spouse's insurance out-of-pocket expenses
Reimbursement for Caregivers for Dependents |
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You will receive a letter if receipts are required.
To avoid having your card suspended, please submit receipts no later than 30 days after the reminder letter is sent to your home. |
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Cannot use the
FSA Card |
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Any non-qualified expense
Any vendor/provider not mentioned above |
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Use another form of payment and submit your claim. |
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