Claims resource center

Use our qualified medical expense tool to view eligible medical FSA expenses. They can also be found in IRS Publication 502. Due to frequent updates to the regulations governing FSAs and HSAs, this list does not guarantee reimbursement but, instead, is to be utilized as a guide for the submission of claims.

Optum payment cards can be used at health care-related merchants, such as hospitals and vision, dental and doctor’s offices. It can also be used at drugstores, pharmacies and grocery stores that have implemented the IIAS (Inventory Information Approval System) or have certified 90% of their gross sales are FSA-eligible. 

As always, save itemized receipts, bills or statements any time the payment card is utilized.

A service or expense must be incurred before it is eligible for reimbursement. An FSA expense is considered "incurred" when the service is performed, not when you pay for the service. In addition, the service must be performed during your participation in the plan. Services or expenses incurred before or after your plan participation dates do not qualify for reimbursement.

WHO: Name of patient (you, your spouse, your dependent)​
WHAT: Description of service​
WHEN: Date of service​
WHERE: Name of provider of the service (person, clinic, hospital, etc.)
HOW MUCH: Amount/cost of the item/service provided

Standard timeline:​

45 days after an unsubstantiated claim is received, an email is sent (or letter, if there is no email address on file)
90 days after the first notification, a second notification is sent​
90 days after the second notification, a third notification is sent

• If your documentation is not received within 15 days of second notification, your card will be suspended and until the expense is substantiated, claims for other expenses will need to be made manually.
• If documentation is still not received by April 30 of the next year, that amount will be added as taxable income on your paycheck and subject to Federal, Medicare, OASDI, and applicable state and local taxes.

One of the following likely happened:

• Amount does not match copay (or up to 5 times the plan amount) or amount on claim file​
• Transactions at stores not IIAS compliant​
• OTC items that require a prescription​

Reimbursement requests that exceed your account balance will be reimbursed up to the amount available in the account.

If you file a manual request for reimbursement of a non-eligible expense, the request will be denied. If you used the payment card and the expense is deemed ineligible after the expense is already paid, you will be required to reimburse your account for that transaction. If you fail to reimburse the account, you may be required to pay income taxes.

The health care reimbursement account can cover medical, prescriptions, hearing, dental or vision expenses that you would otherwise pay for out of pocket. Common qualified expenses that an HCRA will usually cover include the deductible, coinsurance or copayment amounts for your health plan, eyeglasses or contact lenses, dental work and orthodontia, medical equipment, hearing aids and chiropractic care. Many over-the-counter drugs, such as cold and allergy medicines and pain relievers and antacids, can also be reimbursed through an HCRA. For a list of eligible expenses, please see the IRS Publication 502. Another great feature is that the funds are front loaded to the account and are available at the start of your plan year.

A dependent care reimbursement account covers employment-related expenses for childcare. Qualified expenses must be for services that allow you to be able to go to work. Typical expenses under this account include charges for day care, nursery school and elder care (though not if it is for medical care) for your legal tax dependents. The dependent care reimbursement account is not front loaded.

If you file a manual request for reimbursement of a non-eligible expense, the request will be denied.

The IRS regulates Flexible Spending Accounts under IRC 125. According to the IRS guidelines, Dependent Care reimbursement account funds that are not claimed during the plan year are forfeited to the plan. This is called the “use it or lose it” clause. Funds in FSAs subject to this clause are not transferable from one plan year to another, and they are not available for other benefits. The unused funds are retained by the plan sponsor, your employer, and can be used to offset administrative costs of the plan. State of Alabama, FEBB allows you to submit for reimbursement of previous year expenses until March 31 of the current year.

Medical insurance premiums paid for group insurance plan coverage of eligible expenses. Cost for coverage obtained from Medicare, Medicaid and coverage obtained through the Marketplace are not eligible premium expenses.

For employer group coverage, submit a copy of the payroll stub with the holdings of the insurance cost noted. 

For TriCare, submit a copy of the bank statement with the premium withdrawn noted.

Reimbursement requests that exceed your account balance will be reimbursed up to the amount available in the account. 

You are eligible to participate in the LPHRA if your primary medical coverage is with a third-party health care plan not administered by the State Employees’ Insurance Board, including but not limited to Tricare.

Most dental and vision expenses to treat and repair are covered expenses. This would not include cosmetic expenses like non-prescription glasses, contacts, teeth whitening or veneers.

Refer to IRS Publication 502 for the most comprehensive list. You can also use the Qualified Medical Expense Tool | Optum Financial to research covered and not covered expenses.

WHO: Name of patient (you, your spouse, your dependent)​
WHAT: Description of service​
WHEN: Date of service​
WHERE: Name of provider of the service (person, clinic, hospital, etc.)
HOW MUCH: Amount/cost of item/service provided

Reimbursement requests that exceed your account balance will be reimbursed up to the amount available in the account. 

WHO: Name of patient (you, your spouse, your dependent)​
WHAT: Description of service​
WHEN: Date of service​
WHERE: Name of provider of service (person, clinic, hospital, etc.)
HOW MUCH: Amount/cost of item/service provided

One of the following likely happened:

• Amount does not match copay (or up to 5 times the plan amount) or amount on claim file​
• Transactions at stores not IIAS compliant​
• OTC items that require a prescription​

If you file a manual request for reimbursement of a non-eligible expense, the request will be denied.

Reimbursement requests that exceed your account balance will be reimbursed up to the amount available in the account.