FSA Claims and Substantiation

How to File a FSA Claim

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.