Medical Reimbursement/Dependent Care Assistance

Southeast Missouri State University offers a Medical Flexible Spending Account (maximum of $2,650) and Dependent Care Spending Account (maximum of $5,000) benefits for each benefit plan year. Note the Highlights below:

  • The Plan Year is January 1 through December 31 of each benefit plan year. Therefore, claims must be incurred during the Plan Year and submitted by March 31 of the following year.

  • Services must be incurred during the Plan Year and while you are active on the Southeast Missouri State University Flexible Spending Account. If you terminate employment, you are able to submit claims that were incurred prior to your termination date by March 31 of the following year.

  • If you terminate, your Dependent Care balance may be incurred anytime during the Plan Year (before or after your termination) and receipts must be received by March 31 of the following year.

  • All receipts submitted for reimbursement must have a signed claim form.

  • Claims can be filed online, email, fax or mail:

Frates Benefit Administrators
13439 Broadway Extension, Suite 110
Oklahoma City, OK 73114
Phone: (800) 850-7166
Fax: (405) 775-5992
Email: claims@fba-tpa.com
www.fba-tpa.com/semofsa.html

Over-the-Counter Drugs And Medicines Reminder

OTC medications require a doctor’s prescription to be eligible for FSA reimbursement. For that reason, OTC medications cannot be purchased using the MySourceCard® unless dispensed by a pharmacy the same as a standard prescription (with an Rx number). If a manual claim is submitted for purchase of an OTC medication, both a copy of the prescription and the purchase receipt must be included to receive reimbursement.

Non-medicated OTC products (diabetes test strips, saline solution, band aids, etc.) do not require a prescription. You can use either the MySourceCard® to purchase these items or submit the purchase receipt for reimbursement.

Forms

Online Claim Instructions
Medical FSA Claim Form
Dependent Care FSA Recurring Service Form
Dependent Care FSA Claim Form

Special Warning Notification

Your choices under the Medical Reimbursement Plan or Dependent Care Assistance Plan are irrevocable except as determined by IRS rules. If you have money left in either account at the end of the fiscal year for which you can make no claim, it will be forfeited. For these reasons, you must exercise great care in making your decision to participate in either account and great care in determining the amount of money you wish to set aside.

Contact

573.651.2206
Fax: 573.651.2108
humanresources@semo.edu
Academic Hall Room 012
Office of Human Resources
One University Plaza, MS 3150
Cape Girardeau, Missouri 63701