Set Up a Recurring Dependent Day Care Claim

Learn how to submit a recurring Dependent Care (DCA) Claim to get reimbursed as money accrues in your account.
Written by Aimee Reynard
Updated 4 months ago

With a dependent care account (DCA), you can only use money as it accrues in your account. This can make it somewhat monotonous and tiresome waiting for funds to accrue, then submitting multiple claims for reimbursement. Employees are able to set up recurring dependent care claims through their employee account, and would only need to submit a claim once a year. 

NoteUse this mock claim form as an example to learn how to fill out the official Claim Form to set up a recurring reimbursement.

Complete the following steps to set up a recurring claim:

1. Download the Recurring DCA Claim Form

2. Open the downloaded form.

3. Locate Step 1 and fill out the following fields in this section: your employer's name, your name, the last four digits of your Social Security number, and your phone number and email address. 

4. Locate the Dependent Day Care Claims section. 

5. Locate the Dates of Service column and enter the start and end dates of the projected period of time for which you wish to claim.

Note: If you are claiming for the entire plan year, enter the start and end dates of your plan year.

6. Under Provider Name column, enter the name of the Provider. Under Provider Tax ID # column, enter the nine digit provider Tax ID, or Social Security Number if it is an individual.

7. Under the Amount Requested column, enter the entire projected amount of the expense over the requested time period.

Note: If you are claiming for the entire plan year, enter the entire amount of your annual election.

8. Locate the Provider Signature or Stamp field and have the provider/daycare sign in the space provided.

Note: This eliminates the need for any further documentation. If you cannot obtain your provider’s signature or stamp, please provide documentation of the projected expense from the provider, such as a tuition schedule. This documentation must meet the same standards as documentation of any other day care claim, such as Tax ID, type of service rendered, etc.

9. Sign and date the form.

Warning: Review the form and make sure all necessary fields have been filled out before submission. Incomplete forms will be denied.
Note: Complete a direct deposit authorization to receive your reimbursements via direct deposit. You must complete the authorization prior to submitting a recurring claim.

10. Submit your claim (and additional documentation, if necessary) to Ameriflex by any of the following methods:  


       Fax:  888.631.1038 Attention: Claims Department

       Mail: Ameriflex Claims Department P.O. Box 269009 Plano, TX 75026 

       Online account: Upload the completed claim form in lieu of an itemized                 receipt.

Warning: Do not send original documents. If original documents are damaged or lost during processing, they can't be replaced.

You successfully submitted your claim.

Upon receiving your claim, we’ll issue an immediate reimbursement for the available accrued amount in your DCA account.

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