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Eligible Expenses

Orthodontia Eligible Expenses

Orthodontic services are usually provided over an extended period of time. The expenses for the entire period of treatment are sometimes required to be paid upfront — a single total payment at the beginning of the treatment period. Some orthodontists may also accept a substantial initial payment, followed by installment payments during the course of treatment.

Typically, health FSA and HRA expenses must be incurred during the plan year. However, for orthodontia it may be difficult to divide and match up specific services and dates that are related to the total fee since the treatment usually spans beyond the plan year. For these reasons, orthodontia expenses may be reimbursed using one of the following two methods.

Reimbursement Method 1 – Incurred Expense

You may be reimbursed upfront for all qualified expenses paid in the current plan year. Documentation must include the treatment start date, anticipated treatment end date, proof of payment, and a completed Request for Reimbursement Form. Find this form through your personal CONEXIS account at mybenefits.conexis.com.

If payment for orthodontia is made in full, the full contract amount, not to exceed your annual election, will be reimbursed. To receive reimbursement for the full contract amount:

  • Payment must be made within the applicable plan year; and
  • Itemized statement of work or receipt must be provided with your Request for Reimbursement Form.

Example of Incurred Expense for Orthodontia with a 24-month Contract

  • Total cost: $2,500 (including $500 banding fee)
  • Plan year: January – December
  • Treatment start date: February 1, 2015
  • Treatment completion date: January 31, 2017
February 2015: Payment for initial treatment (including banding expenses);
full contract amount paid at initial visit
$2,500
February 2015: Participant submits reimbursement request to include treatment start date, anticipated treatment end date, proof of payment, and a completed Request for Reimbursement Form
Total Orthodontia Treatment Expenses Reimbursable in February 2015
(assuming sufficient account balance is available)
$2,500

Method 2 – Monthly Approach

You may be reimbursed for the initial payment that is usually associated with banding fees. The treatment plan or itemized statement is required with the initial contract/banding reimbursement request. The documentation should include the amount of the initial down payment (usually associated with banding fees), the treatment start date, and anticipated treatment end date.

Thereafter, you may file a monthly reimbursement request for the monthly payment amount. For ongoing monthly reimbursement requests, submit an itemized statement or payment coupon from the provider and a signed Request for Reimbursement Form. Go to mybenefits.conexis.com and log in to your personal CONEXIS account to find this form.

Example of Monthly Expenses for Orthodontia with a 24-month Contract

  • Total cost: $2,500 (including $500 banding fee)
  • Plan year: January – December
  • Treatment start date: February 1, 2015
  • Treatment completion date: January 31, 2017
February 2015: Payment for initial treatment (including banding expenses) $500
February 2015: February regular monthly expense $125
March –
December 2015:
Regular monthly expense, submission of $125 reimbursement request each month (10 months × $125); one separate Request for Reimbursement Form $1,250
2016: Regular monthly expenses; submission of $125 reimbursement request each month (12 months × $125); 12 separate reimbursement requests $1,500
2017: Regular monthly expenses; submission of $125 reimbursement request (1 month × $125); $125
Total Orthodontia Treatment Expense $3,500
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