Having a health savings account (HSA), flexible spending account (FSA), or health reimbursement account (HRA) is a great way to save money on medical expenses. But how do you get reimbursed?
Getting started: Your key documents
An FSA (flexible spending account) and HRA (health reimbursement account) require two forms of documentation. The IRS has strict rules on how FSA/HRA expenses can be paid, so it’s really important to include all of these items:
- CLAIM FORM: Send a completed Health Care Reimbursement Request Form.
- EXPENSE STATEMENTS: Send detailed proof of health care expenses. The IRS requires receipts with ALL of the following:
- Date of service
- Customer (or patient) name
- Name of service provider (health care provider or merchant)
- Service provider contact information
- Type of service
- Description of expenses — Customer cost (the customer’s responsibility for services rendered)
- If you are submitting on behalf of a dependent child, the dependent care provider should document each expense and date of service on the claim form. THE PROVIDER’S SIGNATURE IS REQUIRED.
If this is not possible, you may send itemized receipts including date and type of service provided, name of dependent receiving service, and cost of day care expenses. The IRS requires receipts with ALL of the following:
- Name of care provider
- Dates of service (the start date and end date)
- Type of service
- Name of the dependent who received service
- Cost for day care expenses
How to fill out the claim form
- Download Health Care Reimbursement Request Form
- Read the claim form closely, and call us at 1 (800) 244-6224 if you have questions.
- One claim form can be used to request up to three expenses.
- Use additional claim forms if you need them.
- Mail or fax claim forms to Cigna
- Fax to 1 (877) 823-8953 or 1 (859) 410-2432)
- Or mail to
P.O. Box 182223
IMPORTANT: Please completely fill out the claim form, and remember to sign and date the form. We can’t pay claims without a signed, dated form. Each service should be listed on the claim form.
Sending reimbursement receipts
Detailed proof of health care expenses must be provided for us to process your request. You may send any of these records:
- Expense statements
- Explanation of benefits (EOB) from your health plan
PLEASE NOTE: Credit card receipts cannot be accepted because they do not document the type of service. Cancelled checks are also not acceptable.
Tips for common FSA/HRA claims
- Send a pharmacy receipt showing the prescription details and purchase information.
Over-the-counter (OTC) drugs/products
- Because of the health care reform law, effective January 1, 2011, OTC items described as a drug product will require a doctor’s prescription.
- Each prescription should be included with the OTC receipt for each refund request.
- Please note that many eligible items have specific coverage requirements, such as a medical diagnosis.
- For more details, see a complete list of all expenses that can and cannot be reimbursed
- Send a receipt showing the coverage period (date range) for the premium payment.
FSA, HRA, and HSA Frequently Asked Questions
What FSA expenses, HRA expenses and HSA expenses can be reimbursed?
You can use your HSA or Health Care FSA to reimburse yourself for medical and dental expenses that qualify as federal income tax deductions (whether or not they exceed the IRS minimum applied to these deductions) under Section 213(d) of the tax code.
Your employer determines which health care expenses are eligible under an HRA. To determine if the below listed expenses can be paid by your HRA, please refer to your coverage plan.
Whose expenses can be reimbursed?
- HSA - Money in your HSA can be used to reimburse yourself for medical and dental expenses incurred by you, your spouse, or eligible dependents (children, siblings, parents, and others who are considered an exemption under Section 152 of the tax code).
- Health Care FSA - Money in the FSA can be used to get reimbursed for medical and dental expenses incurred by you, your spouse or eligible dependents (children, siblings, parents and other dependents as defined in your plan documents).
"Medical care" expenses as defined by IRS Code, Section 213(d) include amounts paid for the diagnosis, treatment, or prevention of disease, and for treatments affecting any part or function of the body. The expenses must be to alleviate or prevent a physical defect or illness. Expenses for solely cosmetic reasons generally are not expenses for medical care. Examples include face lifts, hair transplants, and hair removal (electrolysis). Also, expenses that are merely beneficial to one's general health (for example, vacations) are not expenses for medical care.
HRAs can only be chosen together with certain plan types. Your HRA is self-funded by your employer, who is solely responsible for contributing the funds used to pay benefits under your plan using the funds in your HRA. You are not required to make any contribution to the HRA account, either pursuant to a salary deduction election or otherwise under a Section 125 cafeteria plan. You may not enroll under this option if you are considered self-employed (including partners and more-than-2% shareholders in a subchapter S corporation).You cannot open an HSA if, in addition to coverage under an HSA-qualified High Deductible Health Plan ("HDHP"), you are also covered under a Health Flexible Spending Account (FSA) or an HRA or any other health coverage that is not a HDHP.
If you have elected to enroll in an HSA plan, you expressed your interest in opening a Health Savings Account with an HSA service provider. The HSA service provider you choose will contact you and provide you with an HSA enrollment form, a signature card, a request for information for any Customer Identification Program compliance and other related materials necessary to open an HSA account with the HSA service provider. In order to open an HSA with the HSA service provider, you must:
In a timely manner, complete, sign and submit all the forms required by the HSA service provider; and
Be found to meet all of the requirements prescribed by the HSA service provider.
If you are enrolled in a Cigna Individual and Family Health Savings Plan, you will need to contact the HSA service provider of your choice to set up a Health Savings Account to pair with your Cigna Health Savings Plan.
If you are offered a Cigna-administered HDHP through your employer and your employer has not selected the Cigna-preferred HSA service provider, you may open the HSA with an HSA custodian/trustee that is either arranged by your employer or that you personally select. You must agree to complete necessary forms and meet the requirements set forth by the HSA custodian/trustee pertaining to the establishment and operation of your HSA.
The HSA provider and/or trustee/custodian will be solely responsible for all HSA services, transactions and activities related thereto. Neither your employer nor Cigna is responsible for any aspects of the HSA services, administration and operation.
Prior to enrollment with an HSA provider, you must certify that you have enrolled or plan to enroll under a HDHP and are not covered under any other health coverage that is not a HDHP.