FSA Claim Form

The Deadline for Submitting Eligible Expenses to Your FSA for Plan Year 2011 is March 31, 2012!

To avoid FSA forfeiture, you must have your final Plan Year 2010 claim form postmarked (by U.S. Mail, FedEx, UPS or other paid carrier) on or before March 31, 2011. Do not use interagency mail for this filing. All items received by interagency mail after April 1, 2011, will be deemed as not timely filed.

If you have Adobe Professional you can fill out the form and save it as a different file for your records.
Mail the form and receipts to the address on the form or drop them off at the Employees Benefits FSA Department Offices at:

Address: 2401 N. Lincoln Blvd, RM 212, Oklahoma City, OK 73105

Main Phone: 405-522-1190 Fax: 405-522-1175

Autocalculating Flexible Spending Claim Form. The fields will automatically calculate when values are entered in selected fields. This form meets Oklahoma 508 Accessiblity Standards and is using the Employees Benefits Council Bar Code System for documents. This PDF revision requires Adobe Reader 8.0 to use the enhanced features correctly.
    Adobe Reader Icon FSA Claim Form (61k)

Autocalculating Monthly Mass Transportation Expense Form. The fields will automatically calculate when values are entered in selected fields. This form meets Oklahoma 508 Accessiblity Standards and is using the Employees Benefits Council Bar Code System for documents. This PDF revision requires Adobe Reader 8.0 to use the enhanced features correctly.

     Adobe Reader Icon Monthly Mass Transportation (146k)
To generate a prefilled voucher, log in to the BAS site and choose Flexible Spending / File a Claim from the menu.
Remember!
If you do not receive services prior to March 15 and submit the claim prior to March 31st, money left in the plan will be forfeited.

Those links require Adobe Acrobat Reader and a browser version of 6.0 or higher. Firefox and Internet Explorer are supported, although the later is recommended for best viewing. Get a free copy Adobe Acrobat Reader.

Debit Card Purchases

Benny card

Please keep all your receipts.

For example: If you purchase over-the-counter items at places other than IRS-approved merchants*, you will need to send in receipts and a prescription to substantiate your purchases per IRS regulations.

The debit card allows employees to make health care purchases and pay for the purchase through the card program as opposed to paying cash to the provider. This greatly increases the value of the Flexible Spending Account by providing a convenient financing tool to our employees. An option to using the card is to pay for services and then file a paper claim for reimbursement. The paper form of reimbursement requires you to have all your documentation before you can be reimbursed which could take several weeks depending on your insurance company.

Tax Savings

By using Flexible Spending and setting aside pre-tax dollars a person is able to get a medical deduction tax savings without using the IRS long form and attempting to qualify for the deduction based on a percentage of medical bills versus income at the end of the year when filing taxes. The saving comes in the form of being taxed on a reduced amount of income determined by the amount you take out bi-weekly or monthly for your Flexible Spending account. Additionally, the Flexible Spending Account is pre-funded by the Employees Benefits Council, so you can begin using your entire annual election on the first day of the plan year.