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Frequently Asked Questions
  • Health Care Flexible Spending Account (FSA)
    • *Note: This information is general in nature for informational purposes only. Please refer to your employer’s plan for specific information about your plan.
      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.
  • My PayFlex Card®
    • Activating Your PayFlex Card®

      If you receive a PayFlex Card® with an activation label, this means you must activate your card before you can use it. 

      How do I activate my new card?

      If you receive a new card with an activation label, call Card Services at 1-877-261-9951.  This is the same number you will see on the card activation label.  Then enter your card number followed by the # sign.  You will then enter the last four digits of your Social Security number (SSN).  If your SSN is not accepted, you may need to enter the last four digits of your Employee ID number.  Once you finish these steps, your card will be activated.  You can then use your card right away.   
       
      When can I call to activate my card?
      You can call to activate your card as soon as you receive it.  Remember, you only have to activate your card if it has an activation label on it.  To activate your card, call 1-877-261-9951.  This is the same number you will see on the card activation label.  You can call this number at any time. 
       
      After I activate my card, when can I start using it to pay for eligible expenses?
      You can use your card as soon as you activate it.  Note: You must have funds in your account to use the card.  You can view your account balance online on My Dashboard, under Financial Center – My Accounts.
       
      I previously received a card and didn’t have to activate it.  Why do I need to activate my new card?
      Before May 1, 2013, all PayFlex Cards were pre-activated.  That means that you didn’t have to activate your card before using it.  We have changed the activation process to place more security on your card and to decrease the fraud risk.  If your card has an activation label, you must call 1-877-261-9951.  You will have to activate the card before you can use it. 
       
      If I activate my card and then order a card for my spouse or dependent, do they need to activate their new card?
      No.  If your card is already active, your spouse or dependent does not need to activate their new card. This means your spouse or dependent should be able to use their card as soon as they receive it.  Note:  If the card is already active, it will not have an activation label on it.  If someone tries to activate an active card, they’ll hear this message:  “Our records indicate this account has already been activated. Please contact the customer service phone number on the back of your card if you need further assistance.” 
       
      I already have a card and did not have to activate it.  If I order a card for my spouse or dependent, do they need to activate their new card?
      No.  Your spouse or dependent does not need to activate their new card. Your spouse or dependent should be able to use the card immediately, as long as funds are available in your account.  Note: Activation is not required if the card does not have an activation label on it.
       
      If I receive a replacement card, do I need to activate it?
      Yes.  If you receive a new card with an activation label, you must activate the card before you can use it.  To activate the card, call 1-877-261-9951.  This is the same number you will see on the card activation label.  You’ll get a replacement card when your current card expires or if you report your card as lost or stolen.
       
      If I’m unsuccessful in activating my card, how many attempts can I make in a day? 
      You should not have a problem activating your card.  However, you can make two attempts to activate your card each day.  If you’re unable to activate your card after the second try, you must wait until the next day to try again. 
       
      What should I do if I have trouble activating my card or if I have more questions?
      Please call Member Services.  The number is on the back of your PayFlex Card. 
  • All About FSAs
    • Can I change my election during the plan year?
      Due to IRS regulations, your election decision remains in effect for the plan year, unless you have a Qualifying Life Event or status change, such as a marriage, birth or death of a dependent, for example. The process for changing your election due to a status change is ultimately determined by your employer; please contact your Human Resources/Benefits Department to verify this process.
    • Do I have to enroll in my employer’s medical or dental plan in order to participate in an FSA?
      No, enrollment in other group plan(s) is not required in order to participate in an FSA.
    • How do I apply for a change in my election?
      Internal Revenue Service (IRS) guidelines allow you to change your plan contribution during the plan year only for the following qualifying events:
      • Change in legal marital status (marriage, divorce, legal separation, annulment or death of a spouse)
      • Change in number of tax dependents (birth, adoption or death)
      • Change in employment status that affects eligibility
      • Dependent satisfying or ceasing to satisfy coverage requirements (reaching limiting age, gain/loss of student status, marriage)
      • Change in residence that affects eligibility

      The process for changing your election due to a status change is ultimately determined by your employer; please contact your Human Resources/Benefits Department to verify this process.

    • How do I get reimbursed?
      As you incur eligible healthcare and/or dependent day care expenses throughout the year, you can access your funds by using your PayFlex Card® (if offered by your employer) or get reimbursed by submitting a claim.
    • How does an FSA work?
      Managing your FSA is as easy as 1-2-3:
      1. Estimate the amount you will spend on out-of-pocket health care expenses and/or dependent care expenses during the plan year.
      2. Decide how much you wish to set aside into your Health Care FSA and/or your Dependent Care FSA. The amount(s) you wish to set aside will be deducted from your paycheck (on a pre-tax basis) in equal amounts each pay period.
      3. As you incur eligible health care and/or dependent care expenses throughout the year, you can access your funds by using your PayFlex Card® (if offered by your employer) or get reimbursed by submitting a claim.
    • How much money can I expect to save in taxes with an FSA?
      You can save on federal taxes, social security taxes as well as state income taxes in most states. Generally, federal taxes range from 15% to 28% and social security taxes equate to 7.65%. Adding these amounts to your state tax will generally bring your tax savings to approximately 30% on the money you elect to contribute to your FSA.
    • If I participate in the dependent day care FSA plan, do I need to report anything on my personal income tax return at the end of the year?
      Yes, you must identify all persons or organizations that provide care for your child or dependent by filing IRS Form 2441-Child and Dependent Care Expenses, (see Instructions for IRS Form 2441), along with your Form 1040 each year (or Schedule 2 for Form 1040A). Please consult your tax advisor if you have specific questions.
    • If I use the Dependent Day Care FSA, can I also use the federal tax credit for dependent day care expenses?
      Yes; however you cannot use a Dependent Day Care FSA and take a tax credit on your tax form for the same dependent day care expenses. In addition, the maximum amount that you can claim for the tax credit ($6000 with two or more dependents and $3000 with one dependent) must be reduced by your dependent day care account reimbursements. For example, if you have two dependents and contribute $5000 to your FSA, you must subtract that $5000 from your tax credit maximum ($6000) leaving only $1000 in dependent care expenses that you can still claim when filing your federal tax return. Individual situations may differ so please always consult with your tax advisor for specific tax questions.
    • If my spouse and I are employed by the same employer, can we claim each other's expenses on our respective accounts?
      You can either claim your spouse’s expenses on your Healthcare FSA OR your spouse can claim your expenses on his/her Healthcare FSA. You both cannot file for the same expenses under both accounts. In other words, you cannot “double-dip.”
    • Is there a maximum that I can contribute to a Dependent Day Care FSA?
      Yes, the IRS maximum is currently $5,000 per household per plan year.
    • Is there a maximum that I can contribute to a Health Care FSA?
      Yes, the Health Care Flexible Spending Account (FSA) annual maximum contribution amount is $2,600. This limit is on a per-participant basis.  This means, if both you and your spouse are eligible to participate in an employer-sponsored Health Care FSA, you may each contribute up to the individual limit of $2,600 if your spouse’s employer’s plan also offers the IRS maximum of $2,600. Your plan may have a lower limit, so you should check with your Human Resources/Benefits Department or your employer’s plan description to confirm the contribution amount allowed for a Health Care FSA.
    • My enrollment material says that dependent day care expenses must be "work-related." What does "work-related" mean?
      Work-related means that the expenses must be incurred to enable you (and your spouse if married) to work and earn an income. It does not include unpaid volunteer work or volunteer work for a nominal salary. For the IRS definition of work-related expenses, please refer to IRS Publication 503.
    • What expenses are considered eligible expenses under a Dependent Day Care FSA?
      For a listing of eligible expenses, visit Resource Center and click Planning Tools. For more information, please refer to IRS Publication 503.
    • What happens if I leave my company or my employment is terminated?
      Generally, upon termination of employment, you may continue to submit healthcare or dependent day care claims incurred prior to termination and up to the amount of the balance in your account. Claim submission after termination of employment is ultimately determined by your employer; please contact your Human Resources/Benefits Department to verify this information.
    • What happens to the funds left in my account at the end of the plan year?
      If your employer has elected to include a “grace period” within your plan, you have an additional 2 ½ months after the end of your plan year to use your FSA funds. Otherwise, IRS regulations require that any funds left in your account, remain with the plan and regulations do not allow your employer to return these unused funds to you. In most cases, the employer applies any unused funds to the administration fees of the plan. The plan document usually dictates how the employer may use the forfeited funds.

      How do I avoid leaving funds in the plan?
      You can avoid forfeitures by reviewing your prior year’s out-of-pocket expenses to help estimate what you will spend in the next year. Make sure to be conservative and plan for predictable expenses.
    • What is a Flexible Spending Account?
      A Flexible Spending Account (FSA) provides a tax-advantaged way to pay for eligible out-of-pocket health care expenses and work-related dependent day care expenses. Authorized by the Internal Revenue Code, Section 125, an FSA allows you to pay for eligible expenses with “pre-tax” dollars, thereby lowering your taxable income.

      A Health Care FSA allows you to set aside money on a pre-tax basis to pay for qualifying out-of-pocket medical, dental, vision or hearing expenses. Out-of-pocket expenses are those that are not covered by your existing insurance plans. These expenses include deductibles, coinsurance and co-pays and certain over-the-counter (OTC) expenses.

      A Dependent Day Care FSA allows you to set aside money on a pre-tax basis to pay for child or adult day care expenses so that you and, if married, your spouse can work. These expenses include day care, before-and-after school programs, nursery school or preschool, summer day camp and even adult day care.

    • What is the main advantage of enrolling in an FSA?
      The main advantage of an FSA is that you do not pay federal income taxes or social security taxes on the amount you elect to contribute to your FSA. By participating in an FSA, you pay less in income taxes because your contributions are deducted from your pay on a pre-tax basis. Now you can use your tax savings to pay for things you really want—like new clothes, vacations, hobbies or even a gym membership.
  • Healthcare FSA Claim Tips
    • Can I pay my spouse's health insurance premiums through my Health Care FSA?
      Although allowed as a medical deduction for individual taxpayers on their personal income tax returns, insurance premiums are not an eligible expense under IRS Section 125 Health Care Flexible Spending Accounts (FSAs).
    • How does the FSA reimburse orthodontia?
      The IRS recognizes that orthodontia is different from any other type of health care. For reimbursement of orthodontia, what you will need to submit depends on what is allowable under your plan and the payment option that you choose. Please remember to submit to your dental insurance carrier prior to submitting to PayFlex.
      • Coupon Payment Option – If your plan allows, this option works best when the orthodontist provided you either a coupon book or a monthly reminder statement of expenses. You must submit the coupon or itemized statement with a completed claim form. You will do this as the service is provided.

      • Monthly Payment Option (Auto Pay) – If your plan allows, the Auto Pay option allows you to set up recurring monthly reimbursements. To do this, you must submit a copy of the contract or agreement* that you have with the orthodontist along with the completed claim form and the box on the claim form checked indicating you wish to establish automatic monthly reimbursements. The claim form is available in My HealthHub Resources. Once we process the first claim, we will automatically reimburse you each month. You do not have to submit a claim form for each visit. We use the agreement to set the monthly amount that you will receive from the FSA for the length of the agreement. Note: You must be enrolled in the FSA and have funds available. You will receive the monthly payments on or about the due date stated in your agreement.

        *You can obtain a contract/payment agreement from the orthodontist. That agreement must include the following information:
        • Patient name
        • Date the service began
        • Length of service
        • Cost of the initial banding work
        • Dollar amount you must pay each month

        Note: If you use the Auto Pay option, you cannot also use the PayFlex Card® for these expenses.

      • Total Payment Option – Based on your plan, you may have the option to pay the full amount when the treatment begins. If your plan allows and you didpay the full amount, you can receive reimbursement for the amount you paid out-of-pocket. We will reimburse you up to your FSA election amount, minus any previous FSA payments. Note: If you have sent in other claims, make sure to check your FSA balance. You can do this online. This will let you know how much you have available to cover your orthodontia treatment.

        With this option, you must include a copy of your paid receipt. You also need to include an itemized statement. This must includethe following information:
        • Provider name
        • Patient name
        • Date the service began
        • Amount you paid
        • Amount insurance will pay
        Note: You can only submit this once for reimbursement.

      Orthodontia Example: Full payment is made on the first orthodontist visit
      Let’s say you participate in a health care Flexible Spending Account (FSA) in 2015 and 2016. In October 2015, you sign an agreement with an orthodontist for your son. During the first visit (November 2015), your son is X-rayed and fitted for braces. On the second visit (December 2015), the braces are installed. During 15 more monthly visits, the braces will be adjusted. Eventually in 18 months, (if everything goes as planned), the braces will be removed. For these services, the orthodontist charges $2,500 on the date of the first visit, which you pay in 2015.

      Can I be reimbursed the full $2,500 from my 2015 health care FSA?
      Yes, provided you have at least $2,500 available in your FSA. Although your son did not receive all of the care in 2015, the IRS regulations allow the health care FSA to reimburse you for the entire $2,500 as a 2015 expense.

      What if I do not have the full $2,500 remaining in my 2015 health care FSA?
      If you paid the entire orthodontia bill of $2,500 in a lump sum, and your FSA balance is only $2,000, PayFlex® can only reimburse you for the amount available in your account (e.g., $2,000).

      What if my plan includes the grace period, how will my lump sum orthodontia payment be processed?
      It depends on when you paid the lump sum orthodontia expense. Let’s say your orthodontia treatment started in October 2015 and the orthodontist is charging you $2,500. On January 15, 2016, you decided to pay the lump sum amount. Since you paid for the expense during the grace period, you would be reimbursed from the 2015 FSA balance first (if money is still available) and then from the 2016 FSA balance. (Note: the amount you are reimbursed cannot exceed the amount paid to the orthodontist or the total amount of your 2015 and 2016 FSA balances.)


      Orthodontia Example: Orthodontia treatments provided over two plan years
      When treatment is spread over two plan years and you do not pay for the full expense up front, you have two options:
      1. You can pay the monthly payment amount based on the orthodontia agreement by submitting a claim each month with your payment coupon.
      2. You can set up an automatic payment (Auto Pay) with PayFlex® based on the amount set by the orthodontia agreement. To set up Auto Pay, you will need to complete a claim form with the monthly payment amount listed under the Amount Requested column and Ortho – Auto Pay under the Type of Service column. When completing the form, make sure to check the box for Automatic Monthly Reimbursement for Orthodontia expenses. In addition, a copy of the ortho contract/agreement must be sent in with the claim form. Once PayFlex® processes this claim, you will be reimbursed on a monthly basis near the due date stated on your orthodontia contract agreement.
      I am currently set up with PayFlex’s monthly payment option (Auto Pay) for my orthodontia treatment. If I choose not to enroll in an FSA for the following plan year, will the Auto Pay process continue during my grace period (e.g., January 1 – March 15)?
      If you choose not to enroll in an FSA for the following plan year and you have money left in your FSA, the Auto Pay process will automatically continue for the first 2 months of the grace period. The grace period, if offered by your employer, generally covers expenses incurred between January 1 and March 15. With Auto Pay, the orthodontia payments are scheduled based on an amount for an entire month. Therefore, in this situation, the Auto Pay for your January and February payments will be processed. However, the Auto Pay for your March payment will be denied, since coverage ends on March 15 and does not continue for the entire month of March.
    • I elected to contribute $100 per month or $1,200 for the calendar year into a Health Care FSA. If I have $100 in my account in January, but incur a $300 expense, how much can I be reimbursed?
      In this example, your Health Care FSA will reimburse you the full $300. With a Health Care FSA, you are eligible to receive reimbursement up to your annual election amount beginning the first day of your plan year. In other words, you can use your entire election beginning on day 1 of the plan year regardless of whether you have contributed your full election amount on that date.
    • Will I need to submit any additional information to substantiate an expense being claimed for a medically necessary treatment?
      In some cases, you will be asked to provide a "Letter of Medical Necessity" from your physician to substantiate your claim. For example, treatments such as massage therapy or weight loss programs that can be for both medical and non-medical reasons may be subject to this requirement. Visit Resource Center to download a Letter of Medical Necessity form located in Administrative Forms.
  • A Grace Period
    • Do I automatically have this option in my plan?
      It depends if your employer chose this optional feature. Please check with your Human Resources/Benefits Department or your employer’s plan description.
    • How does having the grace period affect my enrollment for the new plan year?
      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.
    • How does PayFlex know which year to apply my grace period expenses to?
      All grace period expenses will be paid out of your “prior” plan year balance automatically, thereby helping to “use up” your prior plan year’s balance first. Once the prior plan year’s balance has been exhausted, the remaining claims will be applied toward the current plan year.
    • My employment terminated during the plan year. Do I still have the grace period?
      No, you must be an active participant on the last day of the plan year in order to be able to incur expenses during the grace period.
    • What if I still have money in my account after the end of the grace period?
      If you have any funds left in your account at the end of the year, they will be forfeited. This is the IRS “use-it-or-lose-it” rule. Review all of your expenses incurred during the plan year. Make sure you have filed a claim for each before the run out period ends. Any funds left in your FSA at the end of the run out period are forfeited.
    • What is a grace period?
      A grace period extends the time that you are allowed to incur eligible health care and/or dependent day care expenses. For a calendar plan year, the timeframe would usually begin January 1 and end on December 31. However with a grace period, you will have an additional 2 ½ months beyond December 31, therefore allowing you to incur expenses up until March 15 of the following year. In other words, you will have a total of 14 ½ months to utilize your 12 month election.
  • All About HRAs
    • How are claims paid if you have both a Health FSA and the HRA?
      When you file a claim (or swipe the health care card at the point of service), the first money that is accessed to pay for the eligible expense comes from your FSA, because that money does not rollover to the next year and you need to use that account first. At the point during the year that you use all of the money in your Health FSA, then funds would come from your HRA. Paper claim forms for the health care FSA and HRA are the same.
    • What is the HRA?
      The Health Reimbursement Account (HRA) is a health care reimbursement account for faculty and staff whose employment began on or before December 31, 2004. Vanderbilt deposits $25 per month ($300 annually) into an account for each eligible faculty and staff member. To access the money in your HRA, you can either swipe the health care card or pay for the item/service at the point of purchase and then submit a claim form to PayFlex.
    • What is the plan year for the HRA?
      The plan year for the HRA is from January 1 to December 31. The deadline to submit claims and supporting documentation (called 'the run-out period') is February 28. Or, for employees who leave Vanderbilt during the year, the deadline to submit claims is 30 days after the termination date.
    • When does my HRA balance from the previous plan year rollover?
      HRA balances roll from year to year. HRA funds remaining at the end of a calendar year should roll forward in early January.
    • Where can I learn more about HRAs?
  • Managing My Settings
    • How do I change my email address?
      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.
    • How do I enroll in direct deposit?
      • 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.

    • How do I sign up for account notifications?
      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.
  • Filing A Claim
    • How do I file an FSA claim?
      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.”
    • What are my options for filing a claim?
      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.
    • What does the term “expense incurred” mean?
      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.
    • What type of documentation is acceptable to submit for reimbursement of health care claim(s)?
      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.

  • Paying for Dental Expenses with your Reimbursement Account
    • How do I know if my account is in overpayment status?
      If your account is in overpayment status, you'll see a message under Alerts on My Dashboard.  If you sign up for the Explanation of Payment (EOP) notifications by e-mail, you'll also get EOPs for overpayment. They're sent from eNotify@payflex.com.  If you don't select the e-mail option for EOP notices, we'll mail the notices to your home address.  We store all documents online, in case you misplace one. 
       

      Access your Explanation of Payment online    
      To view and download notices, log in and select My Documents from the left hand navigation bar. Then select Coupon with EOP Report from the drop down menu. If your account is in overpayment, you'll see the Explanation of Payment notice(s) that have been sent to you.  If your account is in overpayment status, we'll deactivate your card.  You can view your card status online by clicking on Manage My Debit Cards under Quick Links on the left hand navigation bar.
       

      Sign up for account notifications
      Log in 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 email or web alert. To save your changes, click Submit.

    • I received a bill from my dentist for an estimated amount and I used my PayFlex Card® to pay for the bill. Why did I receive an Explanation of Payment notice from PayFlex® that states my account is in overpayment?
      In this situation, your account is in overpayment status because your final patient financial responsibility is unknown.  Once your insurance provider has paid their portion, then the final patient financial responsibility will be confirmed.  To keep your card ACTIVE and avoid overpayment, it is best to not use the PayFlex Card® until insurance has processed the claim and provided you with an Explanation of Benefits showing your final patient financial responsibility.  (See “What should I do if my account is in overpayment status?”)
    • I used my PayFlex Card® at the dentist and it was approved. Why am I receiving a Request for Documentation letter for my dental expenses?
      According to IRS guidelines, PayFlex® is required to verify that all purchases made with your PayFlex Card® are eligible expenses. You will receive a letter since the merchant description from the card swipe does not clarify the date of service, description of service, or your final patient financial responsibility. In order to keep your card ACTIVE, you must provide an Explanation of Benefits from your insurance provider or an itemized statement from your dentist that shows the date of service, description of service, all insurance payments and your final patient financial responsibility for the transactions listed on the letter.
    • I used my PayFlex Card® to pay for my dental expenses and my dentist overcharged me. Who is responsible for fixing this issue?
      If you were overcharged by your dentist, you are responsible for obtaining reimbursement for the amount you were overcharged. In order to keep your PayFlex Card® active and your account in compliance, you must mail PayFlex® a check for the amount you were overcharged to repay your account OR submit a claim for another eligible expense to cover the expense OR have your dentist credit the amount back to your PayFlex Card®.
    • What are my payment options for dental expenses?
      OPTION 1: (Preferred Method)
      Once you receive an Explanation of Benefits (EOB) from your insurance provider, showing your exact patient responsibility, pay for your dental service over the phone by providing the number on your PayFlex Card.

      Benefits:
      • Expense is automatically deducted from your health care account
      • Ensure that you only pay for what you owe
      • Helps keep card active
      • Eliminates claim filing
      Things to consider:
      • You may be required to provide the Explanation of Benefits to PayFlex at a later date to confirm your expense was eligible. Please be sure to keep your EOB.
      • To confirm an expense is eligible, IRS regulations require verification of the date of service, description of service or product and your patient financial responsibility, which is provided on an EOB.
       
      OPTION 2: (Next best method)
      Once you have received dental treatment, pay for the bill with cash, check or personal credit card and submit a claim to PayFlex for reimbursement.  (Make sure to send a copy of your EOB or itemized statement with your claim)

      Benefits:
      • Quick reimbursement
      • Helps keep card active
      • Prevents overpayment status
      Things to consider:
      • If the itemized statement from your dentist indicates insurance has been filed, is pending or is estimated, you must wait and submit your claim after you receive your EOB from your insurance provider.
       
      OPTION 3: (Only if your dentist requires you to pay before insurance pays)
      Once you have received dental treatment, pay for the bill with your PayFlex Card at your dentist office. 

      Benefits:
      • Expense is automatically deducted from your health care account
      • Eliminates claim filing
      Things to consider:
      • If your dentist charges you for an estimated amount OR an amount that is greater than your final patient responsibility (after insurance pays its portion), your health care account will be placed into overpayment* status and action will be required.  *See FAQ - “What does overpayment status mean?” 
      • To resolve your overpayment status, submit payment to PayFlex or submit a claim for a previously unreimbursed eligible expense to repay your FSA.  By taking action, your PayFlex Card will remain active.
      • Should you or your dentist receive reimbursement from any other coverage such as insurance, ask your dental provider to credit any amount received back to your PayFlex Card.  If that is not possible, you are responsible for reimbursing the plan for the amount you overpaid.
    • What does overpayment status mean?
      Overpayment status occurs when you have used the PayFlex Card® to pay for a dental expense and the documentation does not support the amount paid.  For example, if you use your PayFlex Card® to pay for a dental bill that exceeds your final patient responsibility, your account will go into overpayment status OR if you submit an itemized statement from the dentist and it indicates insurance is estimated, pending or filed, the card transaction will be denied until final patient financial responsibility is determined.  Please note, when your account is placed in overpayment status, your PayFlex Card® will be temporarily deactivated until appropriate documentation or payment is provided to PayFlex®.
    • What is the difference between an Explanation of Payment (EOP) from PayFlex® and an Explanation of Benefits from my dental insurance provider?
      An Explanation of Payment from PayFlex® is a document notifying you what claims have been approved for reimbursement, denied, or whether your account is in overpayment status. An Explanation of Benefits from a dental insurance provider is a statement which details what services have been paid by the insurance plan and what is owed to the dentist by the insured individual.
    • What should I do if my account is in overpayment status?
      To keep your account in compliance, you must do one of the following:
      1. Fax, mail or upload a legible copy of the Explanation of Benefits from your insurance provider for the denied expense that indicates the date of service, description of service and final patient financial responsibility to confirm whether the amount equals or exceeds the transaction amount; OR
      2. Fax, mail or upload a detailed receipt or Explanation of Benefits for another eligible expense incurred in the same plan year and having an amount greater than or equal to the original denied expense; OR
      3. Mail a check to PayFlex® for the amount of the original denied expense to repay the plan.
  • Dependent Day Care FSA Claim Tips
    • I just had a new baby and will be home for six weeks. I'm taking my 3-year-old to day care during this time. Will these day care expenses be eligible?
      IRS regulations state that the dependent day care expenses incurred must be due to work-related purposes; therefore, these dependent day care expenses are technically not reimbursable.
    • I pay my neighbor to watch my 13-year-old after school. Is this after-school care considered an eligible expense?
      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.
    • I signed up to contribute $400 per month into my Dependent Day Care Flexible Spending Account (FSA) but my actual expenses are closer to $500 per month. Should I submit my claim form for $400 or for $500?
      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.
    • My 16-year-old daughter cares for my 8-year-old son after school. Can I pay my daughter and file those expenses through my Dependent Day Care FSA?
      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).
    • My child just started kindergarten for which I pay tuition. Is this an eligible dependent day care expense?
      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.
    • What are the requirements for getting reimbursed for dependent day care expenses?
      • 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
    • What expenses are considered eligible expenses under a Dependent Day Care FSA?
      For a listing of eligible expenses, visit Resource Center and click on Planning Tools. For more information, please refer to IRS Publication 503.
    • What if my dependent day care claim amount is greater than my balance?
      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.
    • What type of documentation is acceptable to submit for reimbursement of dependent day care expenses?
      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.
    • When can I submit a claim for my dependent day care expenses?
      Dependent day care claims should only be submitted following the completed dates of service.