Follow these instructions and get your money fast.
We want to make it as easy for you to make withdrawals as possible. BUT ...... we, as the administrators, must follow the rules. Therefore, in order to process your request, we must have the information required to make sure your request is for an allowable expense. Receipts must say who, what, why, where, when, and how much. To assure prompt service, please follow these simple steps.

ALWAYS USE A CLAIM FORM - IT'S SHORT & EASY!
Always fully complete, date, and SIGN a Claim form. You may obtain a claim form from your company administrator or our website. Make as many copies as you need.   Get a form

WITHDRAWING FOR HEALTH CARE EXPENSES

For insured expenses with a co-pay
For prescription drugs, submit a copy of the tag (showing the cost, medication, date of service, and the patient name) attached to the prescription bag. For doctor office visits or other professional providers, submit a copy of the doctor's receipt showing the date of service, the patient's name, preprinted provider information, the treatment rendered, and the amount of the co-pay.

For insured expenses where you pay a deductible or a percentage of the cost
Where you are responsible for a percentage of the expense, before we can reimburse you, you must first submit these types of expenses to your insurance company. Your insurance company will then send you a summary of the claims you submitted indicating what amount, if any, they have paid. This is known as an "Explanation of Benefits'' (EOB). We need a copy of this EOB in order to reimburse you.

For Over-the-Counter Medicines
For over-the-counter medicines, submit a copy of the itemized cash register receipt showing the date, the item and the amount. If FlexBank cannot identify the item from the cash register receipt, we require that you also submit the box top. Please note, for dates of service beginning January 1, 2011, you must have a prescripton for the over-the-counter medicine in order to be reimbursed.

For Orthodontia
For orthodontia, if your company's plan limits reimbursement to a down payment with monthly installments, you will need to first submit a copy of the orthodontic agreement. You will then need to submit either a copy of the payment coupon or a statement showing what you owe for that month.

For uninsured health care expenses
If you are requesting reimbursement for an eligible uninsured expense, you may submit copies of bills directly to us. The bill must show:

	(a) pre-printed provider name & address
	(b) the date of service and the amount of the expense
	(c) the type of service rendered and the patient's name

BALANCE DUE BILLS, VISA RECEIPTS, OR CANCELLED CHECKS ARE NOT ACCEPTABLE!

WITHDRAWING FOR WORK-RELATED DEPENDENT CARE EXPENSES

A receipt must accompany this type of withdrawal for expenses incurred, which should include:

	(a) the provider’s name, address and Tax ID Number or Social Security Number
	(b) the date of service and the amount of the expense