Home Orthodontic Reimbursement Guidelines

Orthodontic Reimbursement Guidelines

2009 Plan Year

Beginning with the 2009 plan year orthodontic expenses will be reimbursed up to the full amount, depending on available FSA balance, of the advance payment that has been paid to the provider. Supporting documentation of services rendered and payment must be submitted and reimbursement may be limited based on the annual election.

  • Total case fee
  • Expected insurance coverage / discounts
  • Initial start and expected length of treatment (in months)
  • Proof of payment (must be made in the 2009 plan year or after)

(If FSA plan year is non-calendar, the new guidelines will only apply once the plan has renewed in 2009)

Below are some examples and key reminders for reimbursing orthodontic treatment.

  • If an employee is currently in an orthodontic agreement and making monthly installments, these amounts are reimbursable as payment is made to the provider
  • If an employee is currently in an orthodontic agreement, any advance payments made in 2009 plan years and forward would be eligible for reimbursement
  • If orthodontics are installed in 2008, but advance payment is made in 2009, this amount may be applied to the 2009 election. Payment date must be within the 2009 plan year coverage period
  • Call FBA at 800-759-4952 with any questions regarding reimbursement

Treatment Prior to 2009

Orthodontic reimbursement procedure

1. When treatment begins, the orthodontist will provide the case fee information, including:

  • Total case fee
  • Expected insurance coverage / discounts
  • Expected length of treatment (in months)
  • Date treatment began

2. An employee will pay the complete fee up front OR pay an initial fee followed by a monthly payment plan.

Provider paid in full

FBA will reimburse 1/3 of the total case fee (after subtracting the amount expected to be paid by insurance up front). The remainder of the total case fee will be distributed equally over the months of treatment.

Payment plan to provider

FBA will reimburse the initial fee and monthly fees that the orthodontist has already calculated as long as the initial fee is not greater than 1/3 of the total case fee.