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.
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.