Orthodontia Quick Reference Guide

Orthodontic treatment is typically provided over an extended period of time. Often, there is no direct relationship between payment and treatment. Some individuals pay for the entire treatment in full, while others pay monthly, over the course of the service period. In both cases, orthodontist visits may occur several times a month or once every few months for adjustments.

Reimbursement from your Health Care Flexible Spending Account (HCFSA) is allowed for pre-paid orthodontia expenses, up to the elected amount, regardless of the actual visit dates. The payment must be made during the period you are covered under the HCFSA and is reduced by any amount paid by any dental or health plan coverage for this service. Please note that dental expenses, other than orthodontia expenses, are only reimbursable for the cost of the services that have already been provided, regardless of when paid.

The expenses of a participant and/or their eligible dependent(s) qualify for reimbursement.

Initial Evaluation Fees
Initial orthodontics expenses such as consultations, moldings, and diagnostic records are reimbursable when incurred (when the services are provided) if the expenses are billed separately from the contracted treatments. Generally, these fees are not included in the total treatment cost and would require a completed claim form and documentation supporting the charges and date of service. These expenses qualify if they are provided while you are covered under the HCFSA.

Initial Fee vs. Down Payment
Typically, providers require a down payment prior to or at the start of orthodontia treatment. This initial service expense is eligible for reimbursement with a fully completed claim form and an itemized bill indicating the initial fee and proof of payment. Payments made prior the start of any services do not qualify for reimbursement. The statements for initial fees must clearly indicate that services have already been provided.

Monthly Payments
The monthly charges for orthodontic treatment is reimbursable from:

  • An orthodontics coupon booklet or a monthly statement indicating the monthly payments, with proof of payment
  • A paid receipt from the orthodontist indicating the payment date
  • A loan coupon (excluding non-qualifying finance charges), and proof of payment
  • A claim form specifically requesting monthly auto payments and the following:
    • A signed contract showing the payment schedule and service period, or
    • A coupon booklet (excluding non-qualifying finance charges), and
    • Proof of contract payment in full

Full Payment for Orthodontic Treatment
If payment is made in full for the orthodontic treatment, and proof of payment is included with the completed claim form, the full payment amount will be reimbursed up to your HCFSA election amount.

Documentation must always be submitted with a signed and completed Tri-Star claim form.

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