Get the free Dependent Care Reimbursement Request Form - BCBSF

MAIL TO: Blue Cross and Blue Shield of Florida Spending Account Administration P.O. Box 45132 Jacksonville, FL 32232-5132 (800) 753-4681 Phone (904) 866-4829 Fax Dependent Care (Daycare) FSA Reimbursement

How to fill out dependent care reimbursement request

1. To fill out a dependent care reimbursement request, start by obtaining the necessary form from your employer or insurance provider. This form may also be available online.
2. Begin by providing your personal information, such as your name, employee ID, and contact details. Make sure to double-check the accuracy of this information.
3. Next, provide information about the dependent for whom you are seeking reimbursement. This includes their name, date of birth, relationship to you, and any other relevant details.
4. Specify the time period for which you are seeking reimbursement. This usually includes the start and end dates of the care provided.
5. Provide details about the care provider. This includes their name, address, phone number, and Social Security number or Employer Identification Number (EIN).
6. Indicate the type of care received, such as daycare, after-school care, or nanny services. Be sure to include any additional details requested, such as the care provider's qualifications or certifications.
7. Detail the expenses incurred for dependent care during the specified time period. This may include the weekly or monthly cost, as well as any additional expenses for supplies or transportation.
8. If your employer offers a flexible spending account (FSA) or any other form of dependent care assistance program, indicate whether you have used these funds for reimbursement. Provide the necessary documentation if required.
9. Finally, review all the information you have provided to ensure accuracy and completeness. Attach any supporting documents, such as receipts or invoices, as required by your employer or insurance provider.
10. Submit the completed dependent care reimbursement request to the appropriate department or individual for processing.

Who needs dependent care reimbursement request?

1. Employees who have dependents and incur expenses for their care while they are working or attending school may need to submit a dependent care reimbursement request.
2. This reimbursement request is typically required by employers or insurance providers who offer a dependent care assistance program or flexible spending account.
3. Individuals who meet the eligibility criteria for dependent care reimbursement, as determined by their employer or insurance provider, will need to complete this request in order to receive reimbursement for their qualifying expenses.

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What is dependent care reimbursement request?

The dependent care reimbursement request is a formal request made by an employee to their employer to receive reimbursement for eligible dependent care expenses.

Who is required to file dependent care reimbursement request?

Employees who have dependent care expenses and a dependent care reimbursement program available through their employer are required to file a dependent care reimbursement request.

How to fill out dependent care reimbursement request?

To fill out a dependent care reimbursement request, employees are typically required to provide information such as the provider's name, address, and taxpayer identification number, the amount and date of the expense, and any supporting documentation such as receipts or invoices.

What is the purpose of dependent care reimbursement request?

The purpose of a dependent care reimbursement request is to request reimbursement for eligible dependent care expenses incurred by the employee.

What information must be reported on dependent care reimbursement request?

The information that must be reported on a dependent care reimbursement request typically includes the date and amount of the expense, the name and address of the care provider, and any necessary supporting documentation.