FLEXIBLE SPENDING ACCOUNTS (FSA)

How to Submit a Claim?

SHPS, Inc. is the FSA claims administrator for LACCD employees. When you have incurred eligible expenses, you can submit your claim form to SHPS in one of two ways:

1. Via fax at (502) 267-2233
2. Via mail to:

   SHPS FSA Administration
   P.O. Box 34700
   Louisville, KY 40232-4700

Download an FSA claim form here (link opens new window).

You can also get a copy of the FSA claim form on the SHPS Web site (after you log in):

www.mySHPS.net (link opens new window)

To be reimbursed for eligible expenses, you must complete and sign the claim form, and submit it along with an explanation of benefits (EOB) or detailed receipt as proof of services rendered. Claims are reimbursed based on the dates of services following the date you are enrolled in the plan. You may submit claims at any time during the current plan year. You also have until March 31 of the next year to submit eligible expenses incurred during the previous plan year.

The following are some reasons why your claim would be denied:

1. No signature or signature in the wrong place on the claim form
2. Incorrect documentation or ineligible expense
3. Charges before participant's effective date with the plan
4. Charges after participant's termination date with the plan

SHPS, Inc. processes and pays claims daily. You have the option to receive payment by check or Electronic Funds Transfer (EFT), which deposits your reimbursement directly into your designated checking or savings account.

Download an Electronic Funds Transfer (EFT) application here (link opens new window).

On average, turnaround from receipt of claim to claim payment is within 5 days. If the reimbursement amount is less than a required minimum payment amount ($25) for your plan, payment will be held until your reimbursement reaches at least the minimum amount.

Note: You may be reimbursed up to the elected annual amount in the Health Care FSA any time during the plan year. However, you can only be reimbursed up to the current contributed amount available in your Dependent Care FSA. Claims for expenses exceeding the accrued amount in your Dependent Care FSA will be reimbursed as the funds accumulate in your account.