Automatic Dependent Care Reimbursement – Eliminates the need to submit substantiation throughout the year for dependent care expenses!

This new process only requires you submit one form per year for each day care provider used during the year.

If your day care expenses exceed your payroll deduction, reimbursement will be automatically sent to you as your payroll contributions are received. If your day care expenses do not exceed your payroll deductions, reimbursement is made monthly for the expenses incurred during that month.

To begin receiving automatic reimbursements, complete the Automatic Dependent Care Request Form found on our website under Printable Forms for FSAs. This form must be completed by you as the participant and by your day care provider. A separate form must be completed for each day care provider if you use more than one.

1. Complete your personal information and information about the dependents receiving the care.

2. Have your day care provider complete and sign the form.

3. You will also need to sign the form.

Remember to also sign up for Free Direct Deposit! Reimbursement will be sent directly to your checking or savings account. No more waiting for a check in the mail! Complete the Direct Deposit form found under printable forms.

* You will only need to complete the Financial Institution Information on the Direct Deposit form (Section 2) if you don’t have a voided or photocopied check.

Fax the Automatic Dependent Care Request Form and Direct Deposit Form to Discovery Benefits (866-451-3245).

Auto reimbursements will begin once your information has been approved. A new Auto Dependent Care Request Form is required for each new plan year for each day care provider.

If there are any changes in the information during the plan year, you must notify Discovery Benefits by completing Step 1A on the Auto Dependent Care Request Form.

Our Participant Services Department is happy to answer any additional questions you may have. A Participant Services Representative can be reached 1-866-451-3399 option one, Monday through Friday from 7:30 am to 7:30 pm Central Time or e-mail customerservice@discoverybenefits.com.