This information is provided as a service for clients of WC Administrators. Some of these answers may be plan specific and will not apply to plans not administered to plans not administered by WC Administrators, LLC.
Claims procedures questions
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How do I submit a claim?
After a service is received, send a claim form and all required proof of service (in the form of a receipt, invoice, bill, etc.) to your plan administrator.
How will my claims be paid?
Once your claim has been evaluated and approved for payment, a check will be issued to you and sent to your company. Your company will then deliver that check to you.
What is " proof of service"?
"Proof of service" is documentation showing the service for which you are requesting reimbursement.
With all medical reimbursement and dependent care claims, we need proof of the following:
- Service rendered: In other words, a description of what type of service was received. (Day care, office visit, prescription, etc.) This may appear on a receipt or statement.
- Date of service: This is the date the actual service was received, not the date payment was made. This date cannot be a future date and must be within the current plan year.
- Payment/expense: A receipt, statement, or cancelled check showing the cost of the service to be reimbursed.
- Name of service provider: If this is not printed on the receipt, we need some other statement or letter linking the service provider and the expense.
It may be necessary for you to submit more than one receipt, statement, bill, or letter in order show all four of these items. For example, you may need to submit a prior bill itemizing services received along with a bill showing the actual amount paid.
Can I claim services received by one of my dependants?
Your cafeteria plan is designed to benefit you as well as your dependents.
Your spouse is considered your dependent. The IRS also considers someone your dependent if he or she:
- is related to you
- is a member of your household
- lives with you more than half the year
- relies on you for more than half of his or her support
- is below age 19 at the end of the calendar year
or is below age 24 and still in school at the end of the calendar year
or has a gross income of less than $3,200.
- is not claimed by another taxpayer
- does not claim others as dependents
In order for us to ensure that your dependents are covered by the plan, we request that you complete the Dependent Designation Form. We will only pay claims for individuals named on this form.
If you gain or lose a dependent due to birth, adoption, death, marriage, divorce, etc. during the plan year, you may contact us to update this information.
What do I do if one of my claims is denied?
If your claim is denied by our office, we will send you a denial letter / request for information. Read this letter carefully. It will explain the reason(s) that your claim was denied. If your claim was denied because of missing or incomplete information, you may resubmit your claim by sending a copy of the denial and the requested information to WC Administrators. If the claim was denied for another reason and you wish to dispute the denial, you may call us at (801) 595-1100.
Where can I get more information about my cafeteria plan?
You can find more information about your plan in the Summary Plan Description given to your company, or by contacting your plan administrator.
Where do I send my claims?
Send your claims to your cafeteria plan administrator. If you are a participant in a plan that WC Administrators administers, you can mail or fax your claims to us. See our
contact us page.
Why was a prescription requested in order to pay my FSA medical claim?
Some services are only eligible for reimbursement if they are prescribed by a doctor to treat a medical condition or illness. In these cases, we must have a prescription or letter from the doctor on file that states the medical condition or illness and the prescribed treatment.
For more information about Eligible Medical Expenses, click on this link