For dependent care expenses and medical costs that you paid for out-of-pocket, CDPHP provides you convenient ways to submit claims.
Submit Your FSA Claim Online
- Log into the secure member site
- Under Online Forms, click FSA Claim Form
- Select Dependent Care Claim or Health Care Claim
- Complete the form and upload your receipts
Submit Your FSA Claim by Mail
- Download and print the FSA Claim Form
- Complete the form. All fields are required.
- Attach copies of your receipts and/or copies of supporting documentation indicating:
- Name of provider
- Date of service or date product was purchased
- Type of service or product (drug name is required for prescription claims)
- Your out-of-pocket expense for the service or product (amount not otherwise reimbursed)
- Name of employee or dependent for whom the service or product was provided
- Amount you paid for service or product
- Mail to: CDPHP Health Funding, P.O. Box 6130, Albany, NY 12206-3960.
Copies of statements, bills, and receipts are sufficient when providing supporting documentation.
Over-The-Counter Drugs
To be eligible for reimbursement, these medications must be prescribed by your doctor. Take your prescription to the pharmacy when you make the purchase, and you’ll be assigned a prescription number, eliminating the need for further substantiation.