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Limited Purpose FSA Card Expense Substantiation Form: Instructions How To Substantiate a Limited Purpose FSA Card Purchase To substantiate a card purchase, you will need to supply a receipt that clearly
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How to fill out limited purpose fsa card

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How to fill out a limited purpose FSA card:

01
Obtain a limited purpose FSA card: Contact your employer or FSA administrator to obtain a limited purpose FSA card. This card is specifically designed for eligible expenses related to dental and vision care.
02
Familiarize yourself with eligible expenses: Before using your limited purpose FSA card, it's important to understand what expenses are considered eligible. Typically, this includes expenses such as dental exams, cleanings, orthodontics, contact lenses, glasses, and more.
03
Keep track of expenses: As you incur eligible expenses, make sure to keep detailed records. This may include receipts, invoices, or statements from healthcare providers. It's important to have documentation as it may be required for reimbursement or audits.
04
Swipe your limited purpose FSA card: When paying for eligible expenses, swipe your limited purpose FSA card just like a regular debit or credit card. However, remember that this card can only be used for dental and vision expenses.
05
Retain documentation: After using your limited purpose FSA card, it's crucial to retain the documentation associated with your expenses. This is necessary for substantiating your claims and may be requested during audits.

Who needs a limited purpose FSA card:

01
Employees with a limited purpose FSA: Limited purpose FSA cards are typically provided by employers to employees who have opted for a limited purpose FSA. These individuals have chosen to allocate a portion of their pre-tax income to cover eligible dental and vision care expenses.
02
Individuals with dental and vision care needs: A limited purpose FSA card is beneficial for individuals who anticipate incurring expenses related to dental and vision care. This may include routine check-ups, orthodontic treatments, prescription glasses, or contact lenses.
By having a limited purpose FSA card, individuals can conveniently access funds allocated for dental and vision care expenses, making it easier to manage and pay for these necessary healthcare services.
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Limited purpose FSA card is a type of flexible spending account card that can only be used to pay for eligible dental and vision expenses.
Employees who have a limited purpose FSA as part of their benefits package are required to file a limited purpose FSA card.
To fill out a limited purpose FSA card, you need to provide information about your dental and vision expenses and submit the card for approval.
The purpose of a limited purpose FSA card is to help employees pay for dental and vision expenses that are not covered by their regular health insurance.
You must report details of your dental and vision expenses, including the date, provider, and cost of each service or product.
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