A receipt or an explanation of benefits from your insurance carrier is needed for each reimbursement claim you submit to your Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA).
Proper expense documentation must include:
Patient Name – the name of the person who incurred the service or expense.
Provider Name – the doctor who provided the service or the merchant where the item was purchased.
Date of Service – the date the service was provided or the date the expense was incurred.
Type of Service – a detailed description of the service received or the item purchased.
Amount - the amount paid for the service or expense and/or the portion that is not reimbursed through your insurance carrier.
For certain expenses, a Letter of Medical Necessity Form from a doctor may be required in addition to an itemized receipt.
When is a Letter of Medical Necessity required?
You may need a Letter of Medical Necessity if your claim is for a product, equipment, or treatment that has both a medical and a non-medical purpose (e.g., mental health therapy, a massage, nasal strips, vitamins, or compression socks). The Letter of Medical Necessity from your doctor must confirm that the item is for medical care and not personal use.
What is a Letter of Medical Necessity?
A Letter of Medical Necessity is a document from your doctor that recommends a particular product, equipment, or treatment for the purposes of medical treatment. The letter typically includes relevant patient information such as medical history, medical needs, and the duration of the treatment needed.
To be acceptable, a Letter of Medical Necessity must include:
Patient Name
Provider Name
Date of Issue
Diagnosis
Service or Supply Needed
Statement or support that service or supply is medically necessary to treat diagnosis
Length of Service (if applicable)
You may ask your doctor to provide this letter to you or you can download our Letter of Medical Necessity Form.pdf to give to your doctor.
How do I submit my expense documentation?
To submit your expense documentation, you must upload and attach it in the claim form. Once the claim is submitted, your benefits administrator will review your claim, including attachments.
A new Letter of Medical Necessity must be provided each Plan Year or each time the treatment changes.
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