The WEX Recurring Dependent Care Request Form is a one-time-per-plan-year authorization that lets WEX reimburse you automatically for ongoing childcare or elder care costs, so you don’t have to submit a fresh claim after every payment. You complete three sections — participant, dependent, and provider — get the provider’s signature, and send it to WEX through the participant portal, the mobile app, fax, or mail. Once it’s approved, reimbursements release as your payroll contributions post to the account. The form is available for download through your WEX participant portal at www.wexinc.com, typically under the Forms or Resources section.1WEX. Recurring Dependent Care Request Form
When This Form Is the Right Choice
The recurring form works best when you pay the same provider a predictable amount on a regular schedule: weekly daycare fees, a fixed monthly rate for before-and-after-school care, an unchanging nanny paycheck. If your dependent care costs swing from period to period, submitting individual claims for the actual amount paid each time will match your reality better.
One eligibility check to run before you fill anything out: your payroll contribution per pay period must be less than your care cost per pay period. The form itself asks you to confirm this. Recurring reimbursement releases when contributions hit the account, so if you’re contributing more per period than you owe your provider, the automation won’t behave the way you expect, and individual claims may be the cleaner path.1WEX. Recurring Dependent Care Request Form
What to Gather Before You Start
Have these items in hand:
- Your full legal name, Social Security number, and Employee ID. Your Employee ID is the identifier your employer uses internally; it isn’t the same as an Employer Identification Number. Check your enrollment paperwork or ask HR if you don’t know yours.
- Each dependent’s name. A child dependent must be under 13 at the time care is provided. An adult dependent must be physically or mentally unable to care for themselves and live in your home more than half the year.2Internal Revenue Service. Physically or Mentally Not Able to Care For Oneself
- The provider’s business name, physical address, and Taxpayer Identification Number.
- The cost per pay period and the start and end dates of service. Both dates must fall within your current plan year.
If you’re paying a relative, that’s allowed with a few exceptions: you cannot use FSA funds to pay your own child under 19, the dependent’s other parent, or anyone you claim as a tax dependent. A grandparent, aunt, or adult sibling outside those categories qualifies as a provider as long as they’ll give you their TIN.
For divorced or separated parents, only the custodial parent can use the Dependent Care FSA for a shared child. Custodial means the parent the child spent the greater number of nights with during the prior year, or, on an even split, the parent with the higher adjusted gross income.
Filling Out the Three Sections
Participant Information
Enter your full legal name (first, middle initial, last), your Social Security number, and your Employee ID.1WEX. Recurring Dependent Care Request Form
Dependent Information
List the name of each dependent receiving care. By signing, you acknowledge that the child is under 13 at the time care is provided, or that the adult dependent meets the self-care incapacity standard.1WEX. Recurring Dependent Care Request Form If you have multiple dependents with different providers or different rates, you may need to submit a separate form for each arrangement.3WEX. WEX Recurring Dependent Care Request Form
Provider Information and Signature
This section is completed by the care provider. The provider enters the business name, physical address, and Taxpayer Identification Number, then the cost per period and the start and end dates of service.1WEX. Recurring Dependent Care Request Form
The provider must then sign the form. That signature is the substantiation: it confirms the provider’s identity, the dates of care, and the dollar amount. Without it, WEX can’t process the form as a substitute for individual receipts.3WEX. WEX Recurring Dependent Care Request Form Keep your own receipts as well; WEX may ask for them.
Submitting the Form to WEX
Once both signatures are on the form, choose one of these channels:
- Online portal. Log in at www.wexinc.com and upload a scanned copy or clear photo of the signed form.
- Mobile app. Use the WEX Benefits app to photograph the document and submit it from your phone.
- Fax. Send to WEX’s benefits processing fax line, listed on your employer’s benefits contact sheet or in your WEX welcome materials.
- Mail. Send to WEX’s processing center; your employer’s benefits documents will have the address.
WEX’s claims guide says submitted documentation is processed within two business days.4WEX Benefits You. Guide to Filing Claims in Your Online Account If WEX needs more documentation, you’ll be notified by email (if one is on file) or by mail. Once approved, the recurring schedule activates and reimbursements release automatically as your payroll contributions post. Payments arrive by direct deposit or mailed check depending on your account setup, and you can change that preference in the portal.
When You Need to Submit a New Form
The form covers a single plan year. You complete a fresh one at the start of every new plan year, even if nothing has changed.
Anything that changes mid-year invalidates the form on file. A new provider, a different rate, a different dependent, a change in the dates of service — any of those means you submit an updated Recurring Dependent Care Request Form right away. WEX’s instructions state directly: “If any information on this request form changes during the plan year, you must submit an updated Recurring Dependent Care Request Form.”1WEX. Recurring Dependent Care Request Form This obligation exists independently of whether you also need to change your annual FSA election, which requires a qualifying life event.
What the Form Will and Won’t Cover
Dependent Care FSA funds cover expenses that let you (and your spouse, if married) work or attend school full-time.5Office of the Law Revision Counsel. 26 U.S. Code 129 – Dependent Care Assistance Programs Eligible arrangements include licensed daycare centers, preschool, before-and-after-school care, summer day camps (including specialty day camps for activities like soccer or computers), au pairs, nannies, and in-home caregivers for qualifying adults.6Internal Revenue Service. Publication 503 – Child and Dependent Care Expenses
Several common expenses do not qualify, and putting them on a recurring form will cause reimbursement problems:
- Overnight camps. The full cost is ineligible even if you try to isolate daytime hours.
- Kindergarten tuition and above. Tuition at kindergarten or higher grades is not a care expense, though before- and after-school programs at the same school can qualify.
- Tutoring, lessons, and summer school. Treated as educational rather than custodial.
- Separately billed food, clothing, field trips, and entertainment, unless they’re incidental and inseparable from the overall care cost.
These distinctions come from IRS Publication 503, which separates “care” from “education.”6Internal Revenue Service. Publication 503 – Child and Dependent Care Expenses If your arrangement combines qualifying and non-qualifying costs, the rate you list on the recurring form should reflect only the eligible portion.