FSA Claim Instructions
Complete all information requested on the claim form or online.
Attach supporting documentation. Substantiation must accompany the claim in order to be considered for reimbursement. Be sure to keep copies of receipts, bills, etc. for your records. Originals will not be returned. All substantiation must include the following items to be eligible for reimbursement:
- Original date of service. (not the date of payment)
- Type of service performed. Refer to list of eligible expenses to identify valid services
- Provider's name and address
- Amount charged to you. Do not include amounts reimbursed by another source
Dependent daycare requests do not require a receipt if the provider signs the claim form. The day care provider also needs to provide their social security number, tax ID number or address.
Submitting a paper claim form
- Make your purchase and keep your receipt
- Download claim form here. You may type directly in the form online and then print or you can print the form and fill it out by hand.*
- Complete all required fields and make sure to sign and date the form. Include your e-mail address if you would like to receive an automatic e-mail notification
- Make copies of your completed form and receipts
- Send the copies to Chard Snyder
FAX: 513-459-9947 or 1-888-245-8452
MAIL: Chard Snyder, 3510 Irwin Simpson Road, Mason, OH 45040
Submitting an online claim
- You will need your receipt or other proof of purchase
- Scan and save your proof of purchase in one of the following formats: Adobe Acrobat (.pdf), JPEG (.jpg), GIF (.gif). The file size may not exceed 2 MB
- Log in as usual (see instructions at right)
- In the portal, go to the Accounts tab and choose File Claims
- When all fields are complete, and your receipt has been uploaded, click the Add Claim button
- Now you may click the Submit Claim(s) button or continue adding claims to the claims basket
- Claims will remain in the claims basket until you click the Submit Claim(s) button, log off or your session expires
- After you submit your claims, you may print a confirmation form for your records
Submitting a Claim Using the Mobile App
You can also use the Chard Snyder mobile app to submit healthcare claims from your iPhone®, Android® or tablet device. Download the Chard Snyder mobile app in your app store, then you can log in and use the app to submit claim information and upload receipts using the camera on your device.
Submitting a claim by email
- Complete a claim form, available here. You may type directly in the form online and then print or you can print the form and fill it out by hand.*
- Scan your completed claim form and proof of purchase as described above
- Attach your claim form and proof of purchase to an email and send it to askpenny@chard‑snyder.com
Tip: Your complete email file, with attachments, may not exceed 7 MB in size. You may send more than one email.
- You may only be reimbursed for eligible expenses incurred during the current plan year
- Payment will be made to you, the participant, only. Payments cannot be made to an alternate payee
- Transfers between healthcare and dependent daycare accounts are prohibited
- Any items for which you are reimbursed cannot be claimed again as deductions or credits on your individual tax return at the end of the tax year
- IRS Guidelines prohibit the advancement of dependent daycare account funds. If a dependent daycare claim is submitted for an amount that is larger than the amount credited to your account, then payments will be issued according to the amount available. Anything requested above the available amount will be released as additional credits are made to your account
* Adobe Reader is required to view and download forms.