Related FSA documents and forms
- Instructions on How to Submit an Online FSA Claim (pdf)
- HCSA Letter of Medical Necessity (pdf)
- FSA Transportation Worksheet (pdf)
- FSA Salary Reduction Form (pdf)
- Request for Reimbursement from your HCSA (pdf)
- Request for Reimbursement from your DCSA (pdf)
- Dependent Care Receipt Template (pdf)
For detailed University of Iowa program information, please review the Flexible Spending Account Program Guide (pdf).
Updated 4/1/2020 due to CARES Act
New Federal regulations included in the CARES (Coronavirus Aid, Relief and Economic Security) Act that was passed on March 27, 2020 establish that distributions from Health Care Flexible Spending Accounts will be allowed to reimburse the cost of over-the-counter medicines or drugs without a prescription. This update is retroactive to purchases made on January 1, 2020 or later. Please visit the Health Care FSA Eligible Expenses page to review what you can be reimbursed for in 2020.