HealthHub

Do I have to enroll in my employer’s medical or dental plan to participate in the health care FSA?
Your plan will determine this. Although your employer can require that you take the medical or dental plan in order to have a health care FSA, not all plans are designed this way. You should check your plan documents to confirm this. 
 
I have a health care FSA. If I’m contributing throughout the year, how much will my FSA cover for a claim in the beginning of the year?
With a health care FSA, your full election amount is available on the first day of the plan year. This means that you can use your entire election on day one of the plan year.
 
Example: You elect to contribute $1,200 for the plan year. In January, you have contributed $100. ($100 x 12 months = $1,200) In that same month, you receive health care services that cost you $1,000. At this point, you haven’t submitted any other claims. This means, you’ll receive the full amount of the claim from your FSA. You don’t have to wait until you actually contribute this amount to your health care FSA.
 
What expenses are eligible under a health care FSA? 
Generally, expenses that are medically necessary are considered eligible. This means if you need the service or product for your health it may be an eligible expense. This includes co-payments, co-insurance and deductibles. You can view a list of common eligible expenses on this website. You can also find more information at www.irs.gov. Refer to IRS Publications 969 and 502. You should also check your plan documents for eligible expenses under your plan.
 
Can I use my FSA to pay for over-the-counter (OTC) items, supplies, drugs and medicines?
Yes. However, there are different rules on how you can use your FSA to pay OTC items, supplies, drugs and medicines. You can use your PayFlex Card® to pay for OTC items and supplies. These include items such as bandages, hot/cold packs, thermometers, first aid kits, home diagnostic tests and diabetic supplies. You can also pay for these items out of pocket and then submit a claim to us. 
 
For OTC drugs and medicines, you can’t use your PayFlex Card. First, you’ll need a written prescription from your doctor. Then you’ll have to pay for the OTC drug or medicine out of pocket and then submit a claim to us. You’ll need to include your written prescription and the detailed receipt with your claim.
 
May I submit eligible health care expenses incurred by my spouse and dependents?
Yes. You can be reimbursed for eligible health care expenses that you, your spouse and eligible tax dependents incur during the plan year. This is true even if you don’t cover your spouse and dependents on your health plan.
 
Why do I have to show that an expense was medically necessary?
There are some products or services that aren’t always used for medical care. Some products may be used for general health reasons. Two examples are massage therapy and weight loss programs. If you use the product or service to treat a medical condition, you’ll need to show that. This is “evidence of medical necessity.” You can submit a prescription or letter from your health care provider. You can also have your health care provider complete and sign a Letter of Medical Necessity form. You can find this form in the Resource Center.
 
Can I pay my spouse’s health insurance premiums through my health care FSA?
No. Premiums aren’t an eligible expense for the health care FSA. You can view a list of common eligible expenses on this website. For more information, visit www.irs.gov. There you can view IRS Publications 969 and 502.

What is a PayFlex Card?
Your PayFlex Card is a debit card. You can use this card to pay for health care products and services. This includes doctor and dentist visits, hospital stays, prescriptions and hearing and vision care. You may also use your card at some discount and grocery stores. These stores must have a system that can process a health care card. Note: The merchants and providers must accept MasterCard® in order for your card to work.

What are the benefits of using a PayFlex Card?
There are four key benefits to the PayFlex Card.

1. Immediate payment from your account – You can use your card at the point of service.
2. Increased personal cash flow – When you use your card you do not have to pay out of pocket.
3. Reduced claim filing – You won’t have to submit a claim and wait for reimbursement. Note: Be sure to keep all of your itemized receipts. You may be requested to submit them.
4. Ease of use – Using your card allows you easy access to your funds.

How does my PayFlex Card work for health care expenses?
You can use your PayFlex Card to pay for an eligible expense. Swipe your card. Select “Credit.” (Though this is a debit card, you will not select “Debit.”) Your transaction will process like any other credit or debit card purchase. Note: The merchants and providers must accept MasterCard® for your card to work. They also must be a health care location (such as a doctor’s office or pharmacy). If they are not a health care location, they must have a system that can process a Health Care card. If you purchase eligible and non-eligible items, you can only use your card to pay for the eligible items. You will have to use another form of payment for the non-eligible items.

When you first receive your card, it is good for five years. Note for FSA: Each year that you enroll, the card will house the FSA plan year election amount. You can only use the card for expenses that you incur during that plan year. This includes a grace period if your employer offers one on the FSA. You should always keep all of your itemized receipts to substantiate card transactions.

Should I select “debit” or “credit” when using my PayFlex Card?
You can use your card as "credit" or "debit."  When you choose "debit", you will need to enter a Personal Identification Number (PIN). To create a PIN, please call 1-888-999-0121.

I just received my PayFlex Card. Do I have to use the card for all of my health care expenses?
No. You do not need to use your card for all health care expenses. You can always use another form of payment for your expenses and submit a claim for reimbursement.

Where can I use my PayFlex Card?
You can use your card to pay for eligible health care products and services. This includes doctor and dentist visits, hospital stays, prescriptions and hearing and vision care. You may also use your card at some discount and grocery stores. These stores must have a system that can process a Health Care card. Note: The merchants and providers must accept MasterCard® for your card to work.

What should I do if my PayFlex Card is not accepted?
There is more than one reason why you may not be able to use your card.

• Some providers do not accept debit or credit cards.
• A merchant or provider may not accept MasterCard®.
• The merchant may not be able to accept health care cards.
• Your account balance may not cover the expense.
• Your account may be suspended. When your account is suspended we need more information regarding another card transaction.

If you are unable to use your card, you will have to use another form of payment. If your plan allows, you can then file a claim for reimbursement.

Can I buy over-the-counter (OTC) items with the card?
You can use your funds to pay for OTC items and supplies. These are items such as bandages or a home diagnostic test. You can also use the funds to pay for diabetic supplies and equipment such as crutches. However, the rules are different for OTC medicines. To use your funds for OTC medicines, you need a written prescription. A standard list of eligible expenses is available online. After logging in, go to My Resources. Click on Planning Tools.

Can I use my PayFlex Card to purchase eligible items online?
Yes. You can use your card for online purchases of eligible items. Please remember to keep any and all receipts.

Do I also need to submit a claim form when I use my PayFlex Card?
If you used your card, please do not submit a claim. However, there may be times when we need more information about the card transaction. We may need you to show documentation that an expense was for qualified medical care. Refer to “What should I do if my account is in overpayment status?”.

How do I access my account information online?
After logging in, from My Dashboard, select Financial Center from the top navigation bar. Then use the drop down menu to select which account you want to view. You can see account information and card transactions.

Why did I receive a Request for Documentation letter?
You recently used your PayFlex Card. You received a letter because we need more information on that card transaction. We need proof that the expense was for qualified medical care. The amount you paid may not match your copay amount. The amount you paid may have been for an estimated amount. We need to know how much you were supposed to pay out of pocket for the claim. Note: If you received this letter, your account may be suspended, if you do not respond by the date indicated. While your account is suspended, you cannot use your card for that account. However, you may request reimbursement by submitting a completed claim.

You can send one of the following items for the transaction in question.

• The best form of proof is the Explanation of Benefits (EOB). You will receive this for any claim that first goes through your medical or dental plan.
• If this is not for a claim that went through your medical plan (for example, an OTC expense), you can use an itemized receipt. The receipt must show the date of purchase or service; the amount you paid; a description of the item or service; and the name of the merchant or provider. Note: If the claim is for an OTC medicine, you must also include a written prescription from your health care provider.
• If you are sending a prescription drug receipt, it must contain the pharmacy name; patient name; date of the prescription; and amount you paid.

Please provide this information as soon as possible. You can upload the documentation online. If you are not able to do this, you can mail or fax it to us. The Request for Documentation letter gives you the instructions for getting that to us. Once we confirm that the amount you paid is an eligible expense, we will re-activate your card.

Note: A cancelled check or credit card receipt alone is not acceptable documentation.

What is an Inventory Information Approval System (IIAS)?
An Inventory Information Approval System (IIAS) is a system that marks a product or service as an eligible health care expense. Stores that sell eligible and non-eligible items must have an IIAS to accept health care cards. These include drug stores, discount stores and grocery stores. These types of stores sell more than just health care items. For example, a drug store also sells newspapers, food items and cosmetics. When you purchase a number of items, the IIAS marks the items that you can pay for with your PayFlex Card. You would then pay for the other items with another form of payment.

What should I do if a store does not have an Inventory Information Approval System (IIAS)?
If the store does not have an IIAS, you can still make your purchase. You will have to use another form of payment. You can then submit a claim for reimbursement.

What happens if I do not have enough money in my account to pay for an expense?
If you do not have enough funds in your account, you PayFlex Card will be denied. You could ask the merchant to charge your card just for the amount that you have available. Then you would pay the balance with another form of payment. Depending on the type of account, you may or may not be able to submit a claim for reimbursement.

• HSA – Once you contribute more funds to your account, you can submit a claim for reimbursement.
• Health Care FSA – With a Health Care FSA, the full amount of your annual election was available on the first day of the plan year. Even though you may still be contributing to the FSA, you will not be able to submit a claim for reimbursement.

What should I do if my card is lost or stolen?
Contact us as soon as possible to report a lost or stolen card to help limit any potential loss or liability as outlined in your cardholder agreement. We can then cancel your card and send you a new one.

If you’re still worried about identity theft after cancelling your card, you can use MasterCard’s Identity Theft Resolution Services at no cost. They can assist you with the process of restoring your identity. Identity Theft Resolution Services include:

• 24/7 access to MasterCard’s certified resolution specialists
• Internet monitoring to proactively detect stolen personally identifiable information and compromised confidential data online
• Assistance from a specialist with notification to all three major credit reporting agencies to place blocks on cardholders’ records and obtain free credit reports
• Assistance with completing paperwork to alert various parties of the potential fraud
• Education about how identity theft can occur and protective measures to avoid further occurrences

To learn more about the Identity Theft Resolution Services, call the MasterCard Assistance Center at 1-800-MC-ASSIST (1-800-622-7747).

MasterCard® is a registered trademark of MasterCard International Incorporated.

No, enrollment in other group plan(s) is not required in order to participate in an FSA.

After you incur an eligible expense, you can:

• Submit a claim online. You can upload or fax your documentation to us.
• Submit a claim using the PayFlex Mobile® app. You can download it for free* from your mobile app store. You’ll use the same username and password that you use for this website.
• Complete a paper claim form and mail or fax it with your documentation. You can find this form in the Resource Center.

*Standard text messaging and other rates from your wireless carrier still apply.   

What do I need to send with my FSA claim?
It depends on your expense type.

If your expense went through your medical or dental plan, you’ll need to send an Explanation of Benefits (EOB) from your plan. This is the best form of documentation.

If your expense didn’t go through your medical or dental plan, you can send an itemized receipt or statement for the expense. It must show the:

• Date of service or purchase
• Amount you were required to pay
• Description of the item or service
• Name of the merchant or provider

If the claim is for an over the counter (OTC) drug or medicine, you must also include a written prescription from your doctor.

For prescriptions, send your detailed receipt. It must include the pharmacy name, patient name, prescription name, date the prescription was filled, and amount you paid.

For dependent care expenses, the dependent care provider must sign the claim form or provide an itemized receipt. It must include the date(s) of service.

Note: If you don’t send an EOB, itemized receipt or statement with your claim, we’ll deny it. We can’t accept a cancelled check, credit card receipt, or billing statement that shows “previous balance,” “balance forward,” “estimated,” “filed,” or “pending insurance.”

After you incur an eligible expense, you have the option of submitting a claim online or completing a paper claim form and mailing or faxing it along with your itemized documentation. To get started, login to your PayFlex account and select File a Spending Account Claim on the left navigation bar or visit Resource Center to download a claim form from Administrative Forms.

IRS regulations say the expense must be incurred before it can be reimbursed. The IRS specifically defines expense incurred as follows: Expenses are treated as having been incurred when you are provided with the health care or dependent day care that gives rise to the expense, and not when you are formally billed or charged for, or pay for the expense.

Here are some examples:

• If your coverage was effective beginning July 1 for the FSA plan, then expenses incurred on or after July 1 can be submitted for reimbursement.
• If you received health care services in December, but waited to pay for those services in January, this would be considered a December expense because the date of service was in December.
• If your dentist said you needed a crown in January, and you prepaid for the crown in December, this would be a January expense because the date of service would occur in January.

Acceptable documentation consists of one of the following:

• An Explanation of Benefits (EOB) is our preferred form of documentation, which is provided to you by your insurance provider.
• An itemized receipt is also acceptable, but it must show the date of purchase or service, amount of purchase or service, description of item or service, name of merchant or service provider, and name of patient if a medical claim.
• Prescription drug receipt containing the pharmacy name, patient name, date the prescription was filled, the name of the drug, and dollar amount.
• Over-the-counter (OTC) items must be clearly described on the receipt. OTC drugs and medicines also require a prescription from your physician in order to get reimbursed.

Please note that a cancelled check is not acceptable documentation.

This would not be considered an eligible expense because the individual being cared for must meet the “qualifying person test” as described by the IRS. A qualifying person includes your dependent who is under age 13 and regularly spends at least eight hours each day in your home.

You can file your claim for the actual amount of charges, in this case $500. However, you will only be paid up to the amount of money available in your account, not to exceed $400. The remaining $100 would be pending until additional funds are deposited into your account.

No. You can only count work-related payments you make to relatives if they are not your dependents. You cannot claim amounts you pay to:

• A dependent for which you or your spouse, if married, can claim an exemption.
• Your child who is under age 19 at the end of the year, even if he or she is not your dependent. (See IRS Publication 503).

The IRS does not consider educational or tuition expenses as eligible expenses, including kindergarten, first grade and higher. However, you can claim expenses for before and/or after-school care provided the care is custodial in nature and not educational.

• You and your spouse, if married, must be earning an income, seeking employment, or a full-time student in order to receive the pre-tax benefits of a Dependent Day Care FSA. Please note; volunteer work or working for a nominal salary is not an acceptable form of employment.
• The expenses must be for a qualifying individual. This includes a dependent of yours younger than age 13, a spouse or another dependent who is physically or mentally incapable of self-care and for whom you can claim an exemption.
• The services must be provided by an eligible provider of child care. This includes a licensed child care facility that complies with applicable state and local laws and any individual who is not your tax dependent or is your child who is 19 or older.
• The expense must be for services already received and not services to be provided in the future.

  For example: If you prepay for a summer day camp for your dependent, reimbursement cannot be provided until after your dependent attends the camp.

• The annual expense reimbursement may not exceed the lesser of:
  • Your earned income;
  • If married, your spouse’s earned income; or,
  • $5,000 ($2,500 if married, filing separate income tax return).
• You must file Form 2441 annually with your individual tax return identifying all dependent care providers

For a listing of eligible expenses, visit Resource Center and click on Planning Tools. For more information, please refer to IRS Publication 503.

If the amount of the claim is greater than your available balance, you will be reimbursed for the amount that is available in your dependent day care account. However, when the next deposit is posted, you will be reimbursed for the remainder of your original claim, up to the amount of the deposit. This process will automatically continue until the entire claim has been paid or until the election amount has been met, whichever comes first.

Acceptable documentation consists of one of the following:

• A completed dependent day care claim form with dates of service, name of dependent, amount requested and day care provider’s name and signature. The claim form can be used as an itemized statement if your day care provider provides this information and signs the form where indicated.
• A completed dependent day care claim form and an itemized statement from your day care provider. The itemized statement must include the provider’s name, your dependent’s name, as well as the specific dates day care services were provided and the cost of care.

Dependent day care claims should only be submitted following the completed dates of service.

It depends if your employer chose this optional feature. Please check with your Human Resources/Benefits Department or your employer’s plan description.

A run out period is the time you have to file claims before the plan year is closed. It is usually 90 days after your plan year ends. For example, your FSA plan year is January 1 through December 31. You would have until March 31 of the next year to file claims. Note: You must have incurred these claims during the plan year.

The grace period extends the plan year. When you incur expenses during the grace period you can receive reimbursement from the prior year FSA. If we use the example above, you have an FSA with a plan year of January 1 through December 31. With the grace period, you can incur expenses through March 15 of the next year. Your run out period may still end March 31. See your employer’s plan documents for information specific to your plan.

With the grace period, you can incur expenses for an additional 2 ½ months into the next plan year to use up your prior plan year’s balance. So, when planning for the next plan year, you need to take into account any money that you still have left in your account that will be used for expenses during that extra 2 ½ month period so that you set your next year’s contribution accordingly.

Login to your PayFlex account and select My Settings on the left navigation bar to get started. Please note, the email address you provide will be used for all account communications.

Login to your HealthHub account and select My Settings on the left navigation bar to get started.

• Login to your PayFlex account and select Financial Center on the top navigation bar.
• Click on Enroll in Direct Deposit on the left navigation bar and complete all required fields.

You may also enroll in direct deposit by completing a paper form available in Resource Center.

Login to your PayFlex account and select My Settings. Then click on the notifications link, enter your e-mail address twice and select the notifications you wish to receive either via e-mail or web alert. To save your changes, click Submit.