HOW CAN I SUBMIT MY REQUEST FOR REIMBURSEMENT?

• For the fastest turnaround use our Online Claim Submission (OCS) tool to send your request electronically.
  
  To forward your Substantiation Cover Sheet and receipts via email or if you have questions specific to OCS, contact our Online Claims Submission Customer Service at ocsclaims@cci-pbs.com.
  
  OR
  
  
• Submit a completed hard copy Claim Form and valid receipts/documentation via one of the following methods:
  • FAX:
    303-221-2785
  • MAIL:
    PLANNED BENEFIT SYSTEMS, INC.
    P.O. Box 4594
    Greenwood Village, CO 80155-4594
  • EMAIL:
    pbsclaims@cci-pbs.com

HEALTH CARE FSA:

• Many of your typical, out-of-pocket health care expenses can be reimbursed under your Health Care FSA. All eligible expenses must meet IRS criteria as a qualified health care expense. For a listing of eligible health care expenses, please refer to our Eligible_Expenses and Eligible_OTC documents. These should not be considered all-inclusive lists.
• Valid documentation / receipts for Health Care claims must include:
  • Name of Service Provider
  • Address of Service Provider
  • Date of Service
  • Cost of Service
  • Description of Service
• In general, cosmetic procedures and services incurred for general well being are not considered to be eligible under the plan. However, if your physician has prescribed one of these services in order to treat a specific medical condition, the service may be considered to be eligible. These types of services do require documentation from your physician indicating the recommended treatment and the specific medical condition for which the treatment is being prescribed. A Certification_of_Medical_Necessity can also be used to substantiate your claim.
• Services must be rendered during the plan year while you're an active participant. If you have entered the plan mid-year or terminated participation, only expenses incurred as an active participant are eligible for reimbursement. You may be eligible to continue in the plan after termination, ONLY if you had a positive account balance at termination and elect COBRA.

DEPENDENT CARE FSA:

• Dependent care claims must include a tax identification number or social security number of your provider and meet the following criteria:
  • Your dependent must be under age 13, unless disabled, and the care must be to allow you and your spouse (if married) to go to work.
  • Overnight camps or extended summer camps (overnight) ARE NOT eligible expenses.
  • The daycare provider must be over age 19, if the care is being provided by a family member.
• Since claims are reimbursed as funds are posted to your account, you may choose to file your expenses as services are provided. Amounts claimed in excess of your current account balance will be held until deposits are made. Once your deposits are posted to your account, your funds will be released automatically.
• Dependent care expenses incurred prior to your plan eligibility are not reimbursable. However, if you terminate employment mid-year you are eligible to submit claims through the end of the plan year even if incurred after termination.

WHEN SHOULD I EXPECT TO RECEIVE MY REIMBUSEMENT?

• Typically, it takes about 7 to 10 business days (3 to 5 business days for online submissions) after we receive your claim form to process a reimbursement check, as long as your claim contains all of the required information discussed above.
• Direct deposit is available and can help expedite your reimbursement. Direct Deposits are usually received within 2-3 business days after your claim is processed. You can indicate on your claim form if you would like to receive your reimbursement via direct deposit by providing your account details in the Reimbursement Information section of the claim form. Or you may complete a Direct_Deposit_Auth form and submit it to PBS at anytime during the year.

DENIED CLAIMS:

• Claims will be returned within 7 business days of receipt if not all the required documentation is included. Cancelled checks, credit card receipts or receipts that only show a "Balance Due" are not sufficient and will not be accepted as valid documentation to support a claim.