Benefits Plans - Flexible Spending Accounts: Dependent Care -
Filing Claims for Reimbursement

You may file a claim for reimbursement after you or your dependent receives the eligible services. You may claim up to the amount you have already contributed to the account at the time your claim is made.

After you incur an eligible expense, you have the option of submitting a claim online or completing a paper claim form and mailing or faxing it along with your itemized documentation.

Submitting a claim online

To submit a claim online you first need to register on umich.healthhub.com by clicking Register on the homepage. Enter your 8-digit UMID as your Member ID (not your Social Security Number) and then enter your zip code. Complete the online registration form.

To reimburse yourself:

  1. Login to umich.healthhub.com by entering your username and password, then click Submit.
  2. Click on File a Claim and select Pay Me.
  3. Enter your claim information: type of expense, date of expense and the amount of expense. To add additional claims, select Add Claim.
  4. Once you have entered in all of your claims, click Submit.
  5. Confirm all expense details, then click Submit. If you need to make changes, click Previous.
  6. Select Fax or Upload for your document choice. In order to upload your receipts, they will need to be scanned into a PDF format.
    • If you selected “Fax,” click on Web Claim Coversheet, then print and sign the form. Fax your claim and itemized receipts to (866) 932-2567.
    • If you selected “Upload,” use the Browse button to upload an electronic document from your computer. To add additional documents, click on Add Additional Documents.
  7. After uploading your documents, you must check the Signature box at the bottom of the page to electronically sign your claim. If submitting dependent care claims, please make sure the provider’s signature is legible.
  8. Click Submit. If you enrolled in eNotify, you will receive an email from PayFlex notifying you when your claim has been processed.

Submitting a Paper Claim via Mail or Fax

  1. Login to your HealthHub account and select My HealthHub Resources to download a claim form from Administrative Forms.
  2. Complete the fillable Form by entering your claim information.
    • Print and sign the form.
    • Mail the completed form and itemized receipts to:

    PayFlex Systems USA
    P.O. Box 3039
    Omaha, NE 68103-3039

    (Or) FAX the completed form along with the itemized
    receipts to (402) 231-4310

You can submit claims for 2013 until May 31, 2014 and submit 2014 claims until May 31, 2015.

Other Important

Submit your dependent care claim after services have been provided. If the expenses are eligible, all necessary documentation has been provided with your claim form, and contributions accumulated in your flexible spending account are equal to or greater than the amount of your claim, you should be reimbursed within ten business days from the date the claim is received by PayFlex.

Documentation that does not contain all the required information will be returned to you and may delay your reimbursement. For example, do not submit cancelled checks or statements showing only the previous balance, amount paid, or balance due.

Federal Form 1040

Amounts you contribute to a Dependent Care Account will be reported on your W-2 Form. Complete and file an IRS Form 2441 (PDF) with your federal income tax return.

Electronic Fund Transfer (EFT)

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Limitations
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.