Must I Substantiate My Claims For Reimbursement?
Yes. The IRS requires specific documentation of eligible expenses. Detailed documentation is
required to substantiate all medical and dependent care claims. Do not include any expenses that
cannot be appropriately documented in your estimated reimbursement calculation, as they cannot be
reimbursed.
What Documentation Must I Provide For Medical Expenses?
Medical expense claims require appropriate documentation such as insurance company Explanation
of Benefits (EOB), medical supply bills, copayment receipts or other third-party documentation
confirming expenses incurred (must identify the provider, the charge, the type of service and the date
of service). Additionally, provider billing statements may also be used, but they must include the
participant name, dates of service, type of service, and in certain circumstances a diagnosis code.
Detailed billing statements or a copy of an EOB or other confirmation of insurance payment (or
declination of payment) is requested to confirm the level of payment already made by an insurance
company or HMO provider. Following are some further guidelines for necessary documentation:
For prescription expenses, a copy of the Rx receipt provided by the pharmacy, indicating name of
medicine, date dispensed, name of person for whom dispensed, and amount paid (a cash register
receipt is not sufficient).
For over-the-counter medicines and other eligible over-the-counter products, a copy of the cash
register receipt (or other similar receipt) itemizing the individual product and date purchased.
For orthodontic treatment, a copy of the treatment plan including the start date, the estimated date
of completion, the total out-of-pocket expense, and any applicable insurance information. For
further details, please visit the VitaFlex website at www.vitaflex.net and click on “Orthodontia
Reimbursement Guidelines”.
Reimbursement of some medical expenses (but not including those listed under the “Therapy”
section on page 7) requires confirmation of medical diagnosis and a statement of the medical
necessity of the treatment. For additional information regarding documentation, please refer to the
VitaFlex website at www.vitaflex.net.
When medical necessity must be confirmed, claims m ust be accompanied by such
documentation.
What Documentation Must I Provide For Dependent Care Expenses?
For dependent care expenses, a receipt is always necessary. The receipt must identify the
dependent’s name, the provider’s name, the dates that care was provided, and the amount charged
for the care. Receipts for home day care may be hand written, but they must include all of the above
requirements as well as the signature of the provider. The receipt must specify the exact dates of care, not simply the dates that payments were made or billed. The Tax ID Number or Social Security Number
of the provider must be included on the claim form or be on file with VitaFlex. Vita also provides the
option of a consolidated Dependent Care Claim. You may use this claim form and have your provider
sign it if this is more convenient for you. Please visit the VitaFlex website to access this form.
What Documentation Is Inadequate?
Documentation for medical expenses must include the provider name, patient name, date of service,
type of service, amount charged, and the amount, if any, covered by insurance. For dependent care,
the information addressed in the above question must be present on all documentation in order to be
considered sufficient. Credit card receipts, balance forward billing statements, and cancelled checks
are all examples of documentation that are not sufficient.
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