Please note: Itemized receipts/statements showing 2.5-Month Grace Period » The 2.5-month grace period allows participants an prior balances or ‘estimated’ insurance payments will not be acceptable. If insurance is indicated, the receipt/ additional period of time to incur expenses after the statement must show insurance payment posted and Plan year ends (December 31, 2023). 昀椀nal patient responsibility. Credit card receipts are » If an expense is incurred between January 1, 2023 and not acceptable forms because they do not provide the speci昀椀c item purchased; therefore, PayFlex cannot March 15, 2024 AND submitted for reimbursement on determine if the expense was an FSA eligible item. or before March 31, 2024, any remaining balance in the previous Plan year that ended December 31, 2023, will I thought purchases at certain vendors were be paid out for the claim, even though the service was automatically substantiated and considered provided in the NEW Plan year. approved purchases? As of February 2009, no additional substantiation is FSA FAQs required for debit card transactions that are approved at What should I do if I receive a substantiation letter or the point of sale by merchants (speci昀椀cally pharmacies) online noti昀椀cation? who have adopted the Inventory Information Approval System (IIAS). The IIAS system compares the SKU on Include these notices when you submit your receipts to the item being purchased to a list of FSA eligible items PayFlex. Keep a copy of these letters and copies of all sold at the store. When a FSA debit card is used, the receipts for your records. You can substantiate a claim by: pharmacy will only allow the card to pay for the FSA eligible items and any non-FSA eligible items will need MAIL FAX UPLOAD to be paid for using an alternative method of payment. If www.pay昀氀ex.com PayFlex Systems USA, Inc. 855-703-5305 Select Learn More merchants still have not adopted this system, FSA debit Flex Claims Department Use letter as your next to Substantiation P.O. Box 981158 cards might not work at their places of business. cover sheet Alert and click El Paso, TX 79998-1158 Upload My Receipts Contact Information: If I do not comply with these substantiation notices, You can reach Customer Service at: 844-729-3539 will I lose the ability to use my debit card? Send Claims To: PayFlex Systems USA, Inc. Yes, if you do not respond within the period of time noted Flex Department on the second noti昀椀cation, your card will be deactivated P.O. Box 981158 until acceptable documentation or payment is provided El Paso, TX 79998-1158 to PayFlex. How can I access my FSA dollars when my debit card is deactivated? You can purchase eligible items or services with another form of payment and submit a claim form along with receipts to PayFlex while your card is inactive. What are acceptable forms of substantiation? » An Explanation of Bene昀椀ts (EOB) is the preferred form of documentation. » An itemized receipt is also acceptable, but it must show: – Date of purchase or service – Amount of purchase or service – Description of item or service – Name of merchant or service provider – Name of patient if a medical claim 42