*Important Note: The FAQs only apply to users who have CDH accounts with Forma, including LPFSA, FSA, DCFSA, and Commuter.

Submit a Manual Claim

When should I submit the manual claims?

When you pay out-of-pocket for CDH accounts eligible expenses, you can submit a manual claim to get reimbursements.

How to submit a manual claim on Forma?

Go to your Forma Portal → Claims → File a Claim. Select the accounts accordingly and fill in all the claim details. See the below article to learn more details on how to manage your CDH accounts on Forma!

Readings: Navigating your Forma Benefits Accounts

If you are an HSA account holder, please see How to Manage Your HSA expenses

What information should be included in the receipt?

Upon your claim submission, you are required to provide your receipt and/or any supporting documents. It can be in the form of a purchase receipt, itemized statement from the provider, explanation of benefits from an insurance carrier, or a bank statement. The documents must include:

  1. Claimant Name

  2. Provider name

  3. Purchased Service/Items

  4. Service Date (Start and End dates are required for DCA claims)

  5. Amount

  6. *LMN (if necessary)

  7. *Rx (if necessary)

Please be advised that we highly encourage you to provide the EOB (Evidence of Benefits) that has run through your insurance carrier for better validation for the review team.

Readings: What are Rx and LMN?

What if I fail to provide the documents?

If documentation cannot be provided or a receipt is submitted that displays an ineligible expense, we will reject the claim. You can resubmit the claim, or provide the supporting documentation to our team.

If you do not have the proper itemized receipt, you may download Forma's LPFSA/FSA Reimbursement Form. You can also download the LMN form HERE.

Why is my receipt submission failed?

Please note that you can only upload a single document up to 10MB in size, or multiple documents up to 30MB in size total. If it keeps failing, please do screenshots instead. If you cannot submit the claim, please reach out to our Member Experience Team for help.

What happens if I submitted a wrong claim? Can you help delete it?

If the amount is not correct, the category is wrong, or the receipt was not provided, please always feel free to reach out to support@joinforma.com for assistance.

How to submit the claim if I cannot access Forma Portal?

If you are temporarily on leave, or you leave the company so that you have lost access to Forma Portal, you can still submit the claim by reaching out to support@joinforma.com.

Readings: How do I submit claims during the run-out period?

Claim Status

When will my claim be reviewed?

After the claim is submitted, it takes 24-72 business hours for our claim review team to review the claim. You will receive the notification letter once the claim is approved or rejected.

Readings: Understand the Claim Status of your Benefits Accounts

Why is my claim denied?

Your claim can be denied due to the following reason:

  1. Insufficient funds in the account

  2. Rx / LMN required but missing

  3. No detailed receipt

  4. Ineligible expense

  5. Expenses incurred before plan effective date

  6. Late submission after the run-out period

  7. Duplicates

If you would like to appeal to the rejected claim, please include the reasons you feel the claim should be approved, as well as any supporting documentation, and reach out to our Member Experience Team via Live Chat or email to support@joinforma.com. You may also reply directly to the claim denial letter.

What happens if my claim amount is higher than my account balance?

  • If FSA/LPFSA/HSA, you will get reimbursed with your available balance only.

  • For DCFSA/Commuter, you will get reimbursed with your available balance, and the remaining will be put on hold and be paid once you have additional contributions to your account.

What is an "On-Hold" claim?

If you submit a claim with an amount higher than your current balance, the over-balance amount will be put on-hold and reimbursed until your balance is renewed.

Readings: What does an "On-Hold" claim mean?

What if my approved claim is later found ineligible or a duplicate?

If such a case happens, please reach out to our Member Experience Team. Your claim will be reversed, and if you are reimbursed, your account will be created with a balance due, and you will be required to pay back the amount.

Reading: What is Balance due and how to offset it?


How will I get reimbursed?

By default, you will be reimbursed via Checks, which will be sent to your address in the ben-admin system.

You can select your reimbursement method in your Forma Portal by going to Settings → Payment → Reimbursement Methods. You can set up your bank account to receive the reimbursements through Direct Deposit.

Readings: Setting Up ACH Reimbursement Payments

Reimbursements for HRA claims depend on your employer's program policy.

When will I be reimbursed?

Payout is processed by the bank every Sunday. If your claim is reviewed by the payout of the week, you would expect the reimbursement in the following week.

As our claim review team reviews the claim in 24-72 business hours, it is safe to submit the claim by Friday to get it approved in time and get paid the next week.

Direct Deposit takes 3-5 days for the money to show up. Checks arrive in 5-7 days after the payout is scheduled, and you might need another 2-3 days for your bank to deposit the funds.

Don't forget you have another option to spend the funds in your benefits accounts - learn how to use your Benefits Cards wisely by checking our Benefits Card FAQs! Also, we have different operations guidelines on your HSA accounts, so don't miss the HSA FAQs if you are an HSA account holder.

Please feel free to reach out to our Member Experience Team via live chat, email to support@joinforma.com, or call us at 844-902-2902 should you have any inquiries.

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