Getting your reimbursement is easy with eBenefits Administrators, Inc. When you incur an eligible health care or dependent care expense, you submit a claim to us for reimbursement. Each claim must be substantiated or validated with a detailed receipt. Always keep back-up copies of your receipts on-hand in case we need to validate any account withdrawals due to IRS requirements.

Note: As of January 1, 2011, FSA, HRA and HSA funds can no longer be used to purchase over-the-counter medicines and drugs unless the medicine or drug is prescribed.

Receipt Requirements

A receipt for any type of medical, prescription, dental or vision service must include: Date of service or prescription fill date Patient name (not required for OTC prescriptions) Place of service/provider name Description of service/item or prescription drug name Cost You may submit your prescription drug information to us in one of two ways as long as the five items listed above are included: submit the Rx script stapled to your prescription bag or ask your pharmacist for a print-out of your prescription drug history for a specific date range. This is useful if you take maintenance medications throughout the year and don't want to bother with saving the small Rx script tags. Most pharmacies will offer this to you at no charge if you ask. A receipt for any dependent care service must include: Provider name, address, and Tax ID number Date(s) of service for the daycare Dependent name(s) Description of service (daycare) Cost Services must be rendered during the plan year and must be incurred prior to reimbursement. Employees may submit one claim form at the beginning of the plan year, and they will be reimbursed according to their care provider's pay schedule. Note: If an employee uses the mySourceCard® MasterCard® Debit Card, they may not need to submit any claims for reimbursement. However, employees are still required to keep back-up copies of all their receipts and documentation.

Claim Filing Forms

All of the necessary claim filing forms can be found in PDF format in our Forms Library.

Claim Processing & Reimbursement

Claims are processed on a weekly basis. All claim submissions must be received by eBenefits Administrators by 5:00 PM three business days prior to the scheduled processing day to be included in that week's reimbursement run. All claims received after the claim submission deadline will be held over until the next processing day. Should you require any further assistance, please feel free to contact us via email at claims@ebeneadmin.com, or call us toll-free at 800.494.6804.