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Frequently Asked Questions
  • All About Flexible Spending Account (FSAs)
    • Note: This information is general in nature for informational purposes only. Please refer to your employer’s plan for specific information about your plan.

      What is a Flexible Spending Account?
      Flexible Spending Accounts (FSAs) let you pay for eligible expenses with tax-free money. You contribute to an FSA with pre-tax money from your paycheck. This, in turn, lowers your taxable income.

      A Health Care FSA helps you pay for eligible out-of-pocket medical, dental, vision and hearing expenses. Out-of-pocket expenses are those that your insurance does not cover. These include deductibles, coinsurance and co-pays and certain over-the-counter (OTC) items.

      A Dependent Care FSA helps you pay for eligible child or adult day care expenses. These expenses are so that you and, if married, your spouse can work, look for work or attend school full-time. These include day care, before- and after-school programs, nursery school or preschool, summer day camp and adult day care. The cost of care must be for your child under age 13, or for a spouse or dependent who is not able to take care of him or herself and who lives with you at least ½ of the year.

      What is the benefit of enrolling in an FSA?
      Your contributions to an FSA are deducted from your pay on a pre-tax basis. Therefore, you pay less in Federal and Social Security payroll taxes. You use those funds in the FSA to help you pay for eligible Health Care and Dependent Care expenses. Then, you can use the tax savings to spend on things you really want—like new clothes, vacations, hobbies or even a gym membership.

      How much money can I expect to save in taxes with an FSA?
      When you contribute to an FSA, that money is deducted from your pay on a pre-tax basis. This means that you pay less in Federal and Social Security payroll taxes. Generally, federal taxes range from 15% to 28% and Social Security taxes are 7.65% of your pay.

      How does an FSA work?
      Managing your FSA is as easy as 1-2-3.
      1. Estimate how much you will spend on eligible health care expenses, Dependent Care expenses or both during the plan year. This is what you pay out-of-pocket.
      2. Decide how much you wish to set aside into your Health Care FSA, your Dependent Care FSA or both up to the IRS limits. Your employer will deduct that amount from your paycheck in equal amounts each pay period. These deductions are pre-tax. Note: These are two separate FSAs. The Health Care FSA cannot pay for Dependent Care expenses. The Dependent Care FSA cannot pay for health care expenses.
      3. As you incur eligible expenses throughout the year, you have two ways to use your funds. If your employer offers the PayFlex Card®, you can use that to pay at the point of service. If you do not have or use the card, you can submit a claim form for reimbursement.

      Can I change my election during the plan year?
      Your FSA election remains in effect for the plan year. This is an IRS rule. The only way to change your FSA election during the plan year is if you have a status change event. Some examples of a status change are marriage and birth or death of a dependent. Please contact your Human Resource or Benefits Department if you wish to change your election based on a status change event.

      How do I change my election?
      Your FSA election remains in effect for the plan year. This is an IRS rule. The only way to change your FSA election during the plan year is if you have a status change event. If you have a status change, the change you wish to make to your FSA must be consistent with the status change event. Here is a list of status change events. Note: Your plan determines which of these are allowed under the plan. Please refer to your plan documents

      • Change in legal marital status (marriage, divorce, legal separation, annulment, death of a spouse)
      • Change in number of tax dependents (birth, adoption, death)
      • Change in employment status that affects benefit eligibility
      • Dependent becomes or is no longer eligible under the plan (reaches limiting age, gains or loses student status)
      • Change in residence that affects eligibility

      A Dependent Care FSA has additional status change events. If you change care providers you may make an elelction change. A change in provider also includes going from having a care provider to not having one (for example, when one parent stops working). If your care provider increases their cost and the provider is not a relative, you may make an election change.

      If you have had a status change event, please contact your Human Resources or Benefits Department within 30 days of the status change event.

      How do I get reimbursed?
      As you incur eligible expenses throughout the plan year, you have two ways to use your funds. If your employer offers the PayFlex Card®, you can use that to pay at the point of service for your health care expenses. If you do not have or use the card, you can submit a claim form for reimbursement.

      What does the term “incurred expense” mean?
      The IRS considers an expense to be “incurred” at the time you receive the care, not when you are billed or pay for the expense. The expense must be incurred within the FSA plan year and while you have coverage for you to receive reimbursement.

      Here are some examples.

      • Your FSA coverage is effective January 1 through December 31 of this year. Expenses that you incur during this period can be reimbursed.
      • You received Health Care services in December of last year. You paid for those services in February of this year. This expense cannot be reimbursed. In this example, you incurred the expense before the start of the FSA plan year.
      • You had dental work done this year, in January. However, you prepaid for the work last December. Though you paid for the work last year, you incurred the expense this year. This expense can be reimbursed from your FSA.
      • You paid for summer day camp in March. Camp begins July 15 and ends July 22. You can be reimbursed for the cost of camp after July 22.

      What happens if I have funds left in my account at the end of the plan year?
      If you have funds left in your account at the end of the year, they are forfeited following the run out period. This is the IRS “use-it-or-lose-it” rule. Your employer may offer a “grace period.” With the FSA grace period, expenses that you incur during an additional two months and 15 days (two and a half months) after the end of your plan year can be paid from your FSA funds.

      You can avoid losing money at the end of the year. Review your current and prior years’ expenses. This will help you estimate what you may spend in the next year. Make sure to be conservative while planning for predictable expenses.

      What is a run out period?
      A run out period is the time you have to file claims before your account is forfeited. 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. Check your employer’s plan documents for your specific run out period.

      What happens if I leave my company?
      When your employment ends, you may continue to submit health care claims incurred during the time you had coverage. Your Health Care FSA may provide coverage through the last day of the month in which your employment ends. If not, then your coverage ends on the last day of employment. In addition, you may be eligible to elect COBRA coverage. Your employer will let you know how and by when to submit claims.

      For your Dependent Care FSA, you may generally continue to submit claims up to the balance in your account. Another option that may be selected by your employer, allows you to only submit claims incurred before your employment ends.

      You should contact your Human Resources or Benefits Department for more information.

      If my spouse and I each have an FSA, can we claim each other's expenses?
      For health care expenses, you cannot claim the same expense for both accounts. In other words, you cannot “double-dip.” If you claim your spouse’s expenses on your FSA then your spouse cannot claim those same expenses on his or her FSA. If your spouse claims your expenses under his or her FSA, then you cannot also claim them under your FSA.

      For Dependent Care expenses, you and your spouse can each have a Dependent Care FSA. However, between the two of you, you are limited to a maximum reimbursement of $5,000 in day care costs which may be reduced based on earned income and tax filing status.

      Health Care Flexible Spending Account (FSA) Carryover FAQs

      These FAQs are general in nature and only apply to you if your employer adopted the carryover. For illustrative purposes, we used the maximum carryover amount of $500 and a plan year that runs from January 1, 2013 to December 31, 2013.  Please refer to your plan documents for more information about how the carryover feature may impact your plan.   
       
      How much of my 2013 FSA funds can I carryover?
      You can carryover up to $500 in unused funds into 2014.  Your employer may decide to allow for a lower amount for the carryover.  Please confirm your carryover amount with your employer.
       
      What if I have more than $500 in unused funds at the end of the 2013 plan year?
      If you have more than $500 in unused funds in your Health Care FSA or Limited Purpose FSA at the end of the plan year, you can still only carryover $500.  Any unused funds above the carryover amount will be forfeited.  Keep in mind your plan may allow for a lower carryover amount.  You can still submit claims through the end of your plan’s run out period.  If you still have 2013 claims, please make sure to submit those before your plan’s run out period, if applicable.
       
      For example, if you have $750 in unused funds on December 31, 2013 and you submit $250 in eligible claims for 2013 by the end of your run out period, you’ll carryover the remaining $500 into 2014.  If you don’t have any eligible claims to submit, you’ll lose $250 and carryover the remaining $500 into 2014.   
       
      When does this change go into effect?
      If you’re enrolled in a Health Care FSA or Limited Purpose FSA for 2013, this change will apply to unused funds in your account on December 31, 2013.  As long as you’re an active employee on the last day of the plan year, you’ll be eligible for the carryover.  Remember, you can only carry over up to $500 in unused funds.  The funds you carry over will be available for 2014 expenses by the end February 2014. 
       
      If my FSA funds carryover into 2014, can I still submit 2013 claims? 
      Yes.  You can still submit claims for 2013 expenses through the end of your run out period.  The run out period gives you more time to submit claims for expenses incurred during the plan year.    Please confirm the claim submission deadline with your employer. 
       
      My FSA had a grace period.  Is that still in place?   
      No.  Since your employer is now offering the carryover, the grace period had to be removed from your plan. The Internal Revenue Service (IRS) allows a carryover or grace period for the Health Care FSA/Limited Purpose FSA, but not both.      
       
      What if I have a Health Care FSA today and want to enroll in a Health Savings Account (HSA) in 2014?
      Under current HSA regulations, you can’t have both a Health Care FSA and an HSA.  We anticipate that the IRS will provide additional guidance on this issue in the near future and we will communicate  any changes as appropriate. 
       
      Will my Health Care FSA or Limited Purpose FSA funds carry over each year?
      Your employer will determine whether or not to allow a carryover for each plan year.  When enrolling in your benefits, you should check with your employer to see if the FSA includes the carryover option.   
       
      Does the amount that I carryover count towards the $2,500* Health Care FSA or Limited Purpose FSA contribution limit? 
      No.  Generally, you can still contribute up to the IRS limit of $2,500 each plan year.  However, your plan may have a lower limit, so you should check with your employer on the maximum amount you can contribute.  If you have a carryover amount, it will be added to the amount you elect to contribute to a Health Care FSA or Limited Purpose FSA.    
       
      Does the carryover apply to my Dependent Care FSA?
      No.  The carryover doesn’t apply to a Dependent Care FSA.  Also, your employer can still offer the grace period for a Dependent Care FSA, even though you have the carryover for the Health Care FSA or Limited Purpose FSA.

  • COBRA & American Recovery & Reinvestment Act (ARRA)
    • Are dependents of an AEI eligible for the COBRA subsidy?
      Yes, as with all COBRA elections, spouse and dependents have an independent right to elect coverage and the dependents’ coverage would also be subsidized.
    • Can I receive COBRA benefits while on FMLA leave?
      The Family and Medical Leave Act, effective August 5, 1993, requires an employer to maintain coverage under any group health plan for an employee on FMLA leave under the same conditions coverage would have been provided if the employee had continued working. Coverage provided under the FMLA is not COBRA coverage, and FMLA leave is not a qualifying event under COBRA. A COBRA qualifying event may occur, however, when an employer's obligation to maintain health benefits under FMLA ceases, such as when an employee notifies an employer of his or her intent not to return to work.
    • Can individuals qualify for longer periods of COBRA continuation coverage?
      Yes, disability can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours. To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must:
      • Have a ruling from the Social Security Administration that he or she became disabled within the first 60 days of COBRA continuation coverage
      • Send the plan a copy of the Social Security ruling letter within 60 days of receipt, but prior to expiration of the 18-month period of coverage
      If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage.
    • Can my COBRA subsidy end early?
      If you fail to pay premiums or you become eligible for coverage under any other group health plan (including that of a spouse) or Medicare, your subsidy can be terminated.
    • Did the health care reform legislation eliminate COBRA?
      No. The new health care reform legislation, The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act, did not eliminate COBRA or change the COBRA rules.
    • Did the health care reform legislation extend the COBRA premium extension?
      No. The new health care reform legislation, The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act, did not extend the eligibility time period for the COBRA premium reduction. Eligibility for the subsidy ends May 31, 2010; however, those individuals who become eligible on or before May 31, 2010 can still receive the full 15 months as long as they remain otherwise eligible.
    • Did the health care reform legislation extend the time period I can have COBRA beyond 18 months?
      No. The new health care reform legislation, The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act, did not extend the maximum time periods of continuation coverage provided by COBRA. COBRA establishes required periods of coverage for continuation health benefits.
    • Does the COBRA subsidy extend my COBRA coverage?
      The subsidy does not extend your COBRA coverage. The COBRA coverage period is determined from the start of your original COBRA coverage eligibility date.
    • How do I file a COBRA claim for benefits?
      Your health plan rules should include how to obtain benefits and written procedures for processing claims. View your Summary Plan Description for claims procedures. You should submit a claim for benefits in accordance with the plan's rules for filing claims.
    • How do I find out about COBRA coverage and how do I elect to take it?
      Employers or health plan administrators must provide an initial general notice if you are entitled to COBRA benefits. You probably received the initial notice about COBRA coverage when you were hired.
      • When you are no longer eligible for health coverage, your employer has to provide you with a specific notice regarding your rights to COBRA continuation benefits.
      • Employers must notify their plan administrators within 30 days after an employee's termination or after a reduction in hours that causes an employee to lose health benefits.
      • The plan administrator must provide notice to individual employees of their right to elect COBRA coverage within 14 days after the administrator has received notice from the employer.
      • You must respond to this notice and elect COBRA coverage by the 60th day after the written notice is sent or the day health care coverage ceased, whichever is later. Otherwise, you will lose all rights to COBRA benefits.
      • Spouses and dependent children covered under your health plan have an independent right to elect COBRA coverage upon your termination or reduction in hours. If, for instance, you have a family member with an illness at the time you are laid off, that person alone can elect coverage.
    • How does a person become eligible for COBRA continuation coverage?
      To be eligible for COBRA coverage, you must have been enrolled in your employer's health plan when you worked and the health plan must continue to be in effect for active employees. COBRA continuation coverage is available when a qualifying event occurs that would cause an individual to lose his or her health care coverage.
    • How long after a qualifying event do I have to elect COBRA coverage?
      Qualified beneficiaries must be given an election period during which each qualified beneficiary may choose whether to elect COBRA coverage. Each qualified beneficiary may independently elect COBRA coverage. A covered employee or the covered employee's spouse may elect COBRA coverage on behalf of all other qualified beneficiaries. A parent or legal guardian may elect on behalf of a minor child. Qualified beneficiaries must be given at least 60 days for the election. This period is measured from the later of the coverage loss date or the date the COBRA election notice is provided by the employer or plan administrator. The election notice must be provided in person or by first class mail within 14 days after the plan administrator receives notice that a qualifying event has occurred.
    • How long does COBRA coverage last?
      COBRA establishes required periods of coverage for continuation health benefits. A plan, however, may provide longer periods of coverage beyond those required by COBRA. COBRA beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
    • How long is the COBRA subsidy?
      The subsidy is for a maximum of 15 months.
    • I am eligible for the premium reduction and have been enrolled in COBRA coverage since before the ARRA’s enactment. Can I get a refund of 65% of the premiums I have paid prior to the law’s enactment?
      No. The premium reduction provisions apply only to premiums for coverage periods beginning on or after February 17, 2009. If you were eligible for the reduction but paid in full for periods of COBRA coverage beginning on or after February 17, 2009, you should contact the plan administrator or employer sponsoring the plan to discuss a credit against future payments.
    • I’ve heard that high income individuals do not qualify for the COBRA subsidy. Is that true?
      If an individual's modified adjusted gross income for the tax year in which the premium assistance is received exceeds $145,000 (or $290,000 for joint filers), then the amount of the premium reduction during the tax year must be repaid.

      For taxpayers with adjusted gross income between $125,000 and $145,000 (or $250,000 and $290,000 for joint filers), the amount of the premium reduction that must be repaid is reduced proportionately. Individuals may permanently waive the right to premium reduction but may not later obtain the premium reduction if their adjusted gross incomes end up below the limits. If you think that your income may exceed the amounts above, consult your tax preparer or contact the IRS at www.irs.gov.

    • If I am an AEI that has COBRA coverage ending due to nonpayment of premiums, am I responsible for past due premiums?
      Individuals who have reached the end of the original premium reduction period will have additional time to pay extension-related reduced premiums that were due prior to notice being provided. To continue their coverage they must pay the 35 percent of premium costs by the later of February 17, 2010, 30 days after notice of the extension is provided by their plan administrator, or the end of the otherwise applicable payment grace period.

      Individuals who lost their subsidy and paid the full 100 percent premium for December 2009 should contact their plan administrator or employer sponsoring the plan to discuss a credit for future months of coverage or a reimbursement of the overpayment.

      If you did not pay premiums to the end of the original premium reduction period, you will not have an opportunity to re-enroll.

    • If I am an AEI who did not originally elect COBRA and I would now like to elect COBRA and take advantage of the subsidy, how does this affect my COBRA end date?
      If you did not elect COBRA during your initial 60 day election period, you will not be allowed an opportunity to elect.
    • If I elect COBRA, how much do I pay?
      When you were an active employee, your employer may have paid all or part of your group health premiums. Under COBRA, as a former employee no longer receiving benefits, you will usually pay the entire premium amount, that is, the portion of the premium that you paid as an active employee and the amount of the contribution made by your employer. In addition, there may be a 2 percent administrative fee.

      Since it is likely that there will be a lapse of a month or more between the date of layoff and the time you make the COBRA election decision, you may have to pay health premiums retroactively-from the time of separation from the company. The first premium, for instance, will cover the entire time since your last day of employment with your former employer.

    • If I waive COBRA coverage during the election period, can I still get coverage at a later date?
      If a qualified beneficiary waives COBRA coverage during the election period, he or she may revoke the waiver of coverage before the end of the election period. A beneficiary may then elect COBRA coverage. Then, the plan need only provide continuation coverage beginning on the date the waiver is revoked.
    • Is a divorced spouse entitled to COBRA coverage from their former spouses’ group health plan?
      Under COBRA, participants, covered spouses and dependent children may continue their plan coverage for a limited time. A covered employee’s spouse who would lose coverage due to a divorce may elect continuation coverage under the plan for a maximum of 36 months. A qualified beneficiary must notify the plan administrator of a qualifying event within 60 days after divorce or legal separation. After being notified of a divorce, the plan administrator must give notice to the qualified beneficiary of the right to elect COBRA continuation coverage.
    • Under COBRA, what benefits must be covered?
      Qualified beneficiaries must be offered coverage identical to what is available to those individuals who are not receiving COBRA coverage under the plan (generally, the same coverage that the qualified beneficiary had immediately before qualifying for continuation coverage). A change in the benefits under the plan for the active employees will also apply to qualified beneficiaries. Qualified beneficiaries must be allowed to make the same choices given to non-COBRA beneficiaries under the plan, such as during periods of open enrollment by the plan.
    • What are the changes in the Department of Defense Appropriations Act, 2010?
      The 2010 DOD Act extended the COBRA premium reduction eligibility period for two months until March 31, 2010, and increased the maximum period for receiving the subsidy for an additional six months (from nine to 15 months).

      Individuals who have reached the end of the original premium reduction period will have additional time to pay extension-related reduced premiums that were due prior to notice being provided. To continue their coverage they must pay the 35 percent of premium costs by the later of February 17, 2010, 30 days after notice of the extension is provided by their plan administrator, or the end of the otherwise applicable payment grace period.

    • What changes did the Trade Act of 2002 and the TAA Health Coverage Improvement Act of 2009 make with regard to COBRA continuation coverage?
      The Trade Act of 2002 created a tax credit for certain individuals who become eligible for trade adjustment assistance and for certain retired employees who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC). Under the tax provisions, eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance, including continuation coverage.

      The TAA Health Coverage Improvement Act of 2009 section of ARRA made several amendments to these provisions, including an increase in the amount of the credit to 80% of premiums for coverage before January 1, 2011 and temporary extensions of the maximum period of COBRA continuation coverage for PBGC recipients (covered employees who have a non-forfeitable right to a benefit any portion of which is to be paid by the PBGC) and Trade Adjustment Assistance eligible individuals.

      If you have questions about these provisions, you may call the Health Coverage Tax Credit Customer Contact Center toll-free at 1.866.628.4282. TTD/TTY callers may call toll-free at 1.866.626.4282.

    • What coverage is subject to this law?
      All plans are subject to this new COBRA legislation (ARRA) EXCEPT Healthcare FSAs. This includes medical, prescription only, dental only, vision only, Health Reimbursement Accounts, and Employee Assistance Programs.
    • What happens if I forget to pay my premium?
      If premiums are not paid by the first day of the period of coverage, the plan has the option to cancel coverage until payment is received and then reinstate coverage retroactively to the beginning of the period of coverage.
    • What if I am a high income individual and do not want to take the COBRA subsidy?
      You will be given the opportunity to permanently waive the subsidy.
    • What if I did not elect COBRA initially?
      If you did not elect COBRA initially, the 2010 DOD Act does not allow another opportunity to elect.
    • What if I elected COBRA but ended early due to nonpayment of premiums?
      Individuals who have reached the end of the original premium reduction period will have additional time to pay extension-related reduced premiums that were due prior to notice being provided. To continue their coverage they must pay the 35 percent of premium costs by the later of February 17, 2010, 30 days after notice of the extension is provided by their plan administrator, or the end of the otherwise applicable payment grace period.

      Individuals who lost their subsidy and paid the full 100 percent premium for December 2009 should contact their plan administrator or employer sponsoring the plan to discuss a credit for future months of coverage or a reimbursement of the overpayment.

      If you did not pay premiums to the end of the original premium reduction period, you will not have an opportunity to re-enroll.

    • What if I think I am eligible for the COBRA subsidy but my employer indicated that I was not involuntarily terminated?
      If your employer has determined that you were not involuntarily terminated and therefore, not eligible for the premium reduction, you can request an expedited review of your employer’s denial from the Department of Labor (DOL). The DOL will make a determination regarding the appeal within 15 business days after receiving the completed application for review. Appeals to the Department of Labor must be submitted on a U.S. Department of Labor application form, available at www.dol.gov/COBRA.
    • What if my COBRA subsidy ends before my COBRA coverage ends?
      If your subsidy ends before the end of your COBRA period, you will be able to continue coverage at the full monthly premium rate until the end of your coverage timeframe.
    • What is an Assistance Eligible Individual?
      An Assistance Eligible Individual (AEI) is an individual who is involuntarily terminated between September 1, 2008, and March 31, 2010. Spouses and dependents of the involuntarily terminated individual can also be an AEI.
    • What is COBRA?
      COBRA provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. This coverage, however, is only available when coverage is lost due to certain qualified events.
    • What is the American Recovery & Reinvestment Act?
      The American Recovery and Reinvestment Act of 2009 (ARRA), as amended on December 19, 2009, by the Department of Defense Appropriations Act, 2010 (2010 DOD Act), and further amended on March 2, 2010 by the Temporary Extension Act of 2010, provides premium reductions for health benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA. Eligible individuals pay only 35 % of their COBRA premiums and the remaining 65 percent is reimbursed to the coverage provider through a tax credit. To qualify, individuals must experience a COBRA qualifying event that is the involuntary termination of a covered employee's employment. The involuntary termination must occur during the period that began September 1, 2008, and ends on March 31, 2010. The premium reduction applies to periods of health coverage that began on or after February 17, 2009, and lasts for up to 15 months.
    • What is the definition of involuntary termination?
      Involuntary termination is defined as termination of employment whereby the employee did not take any action to initiate the termination. This includes layoffs, downsizing, and terminations for cause (excluding gross misconduct).
    • What is the subsidy amount?
      If you qualify for the subsidy, you will be required to pay 35% of the monthly premium for the benefits you choose to enroll in, with the exception of any Healthcare Flexible Spending Account or life insurance plan, and the Government will pay 65% of the monthly premium.
    • What is the Temporary Extension Act of 2010?
      The Temporary Extension Act of 2010 extends eligibility for the premium assistance to events occurring through March 31, 2010.

      A new provision in the Temporary Extension Act of 2010 includes the following as a qualifying event for purposes of ARRA:

      • Involuntary termination of employment that occurs on or after March 2, 2010 and follows a qualifying event that was a reduction of hours and that occurred at any time from September 1, 2008 and March 31, 2010.

      In addition the Extension Act allows employees to receive the subsidy if they initially lost coverage due to a reduction of hours and were later terminated after enactment of the bill.

    • What process must individuals follow to elect COBRA continuation coverage?
      Employers must notify plan administrators of a qualifying event within 30 days after an employee's death, termination, reduced hours of employment or entitlement to Medicare.

    • When are COBRA premiums due?
      The initial premium payment must be made within 45 days after the date of the COBRA election by the qualified beneficiary. Payment generally must cover the period of coverage from the date of COBRA election retroactive to the date of the loss of coverage due to the qualifying event. Premiums for successive periods of coverage are due on the date stated in the plan with a minimum 30-day grace period for payments. Payment is considered to be made on the date it is sent to the plan.
    • When does COBRA coverage begin?
      COBRA coverage begins on the date that health care coverage would otherwise have been lost due to a qualifying event.
    • When does the COBRA subsidy begin?
      The premium reduction for COBRA continuation coverage is available to an "Assistance Eligible Individual" who has a qualifying event for continuation coverage under COBRA, which is the employee's involuntary termination at any point from September 1, 2008, through March 31, 2010, and elects COBRA coverage timely.

      Those who are eligible for other group health coverage (such as a spouse's plan) or Medicare are not eligible for the premium reduction. There is no premium reduction for periods of coverage that began prior to February 17, 2009.

    • When will COBRA subsidy-eligible participants be notified?
      Letters notifying participants of the subsidy extension were sent to participants between January 20 and January 29, 2010.
    • Who is eligible for the COBRA subsidy?
      Employees (and their dependents) who have been involuntarily terminated between September 1, 2008 and March 31, 2010 are eligible for the COBRA subsidy.
    • Who is entitled to benefits under COBRA?
      There are three elements to qualifying for COBRA benefits. COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events:
      • Plan Coverage - Group health plans for employers with 20 or more employees are subject to COBRA. Both full and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of an employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full time.
      • Qualified Beneficiaries - A qualified beneficiary generally is an individual covered by a group health plan on the day before a qualifying event. This includes an individual who is either an employee, the employee's spouse, or an employee's dependent child. In addition, any child born to or placed for adoption with a covered employee during the period of COBRA coverage is considered a qualified beneficiary. Agents, independent contractors, and directors who participate in the group health plan may also be qualified beneficiaries.
      • Qualifying Events - Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA.
      Qualifying Events for Employees:
      • Voluntary or involuntary termination of employment for reasons other than gross misconduct
      • Reduction in the number of hours of employment
      Qualifying Events for Spouses:
      • Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct
      • Reduction in the hours worked by the covered employee
      • Covered employee's becoming entitled to Medicare
      • Divorce or legal separation of the covered employee
      • Death of the covered employee
    • Who pays for COBRA coverage?
      As an individual that has experienced a qualifying event (e.g. termination of employment or reduction in hours), it is your responsibility to pay for COBRA coverage even if you do not receive a monthly statement. Beneficiaries may be required to pay for COBRA coverage.
  • HSAs Simplified
    • Are my funds FDIC insured?
      All participant funds that are not invested in the available mutual fund options are separately insured by the FDIC pursuant to Treasury Regulation 12 C.F.R. § 330.5.
    • Can a health plan that does not have a deductible for preventive care still qualify as an HSA-compatible health plan?
      A plan does not fail to be treated as an HSA-compatible health plan merely because it does not have a deductible (or has a small deductible) for preventive care. For this purpose, preventive care includes such items as periodic health evaluations, routine prenatal and well-child care, child and adult immunizations, tobacco cessation programs, obesity weight-loss programs, and certain screening services.
    • Can a health plan that imposes a lifetime limit on benefits still qualify as an HSA-compatible health plan?
      A plan does not fail to be treated as an HSA-compatible health plan merely because it imposes a reasonable lifetime limit on benefits provided under the plan. In this case, amounts paid above a lifetime limit will not be treated as out-of-pocket expenses in determining the annual out-of-pocket maximum.
    • Can I be covered by another health plan and still be eligible to contribute to an HSA?
      You only remain eligible to contribute to an HSA if the additional health plan is a qualified HSA-compatible health plan.
    • Can I have a Flexible Spending Account (FSA) with an HSA?
      If you are enrolled in an HSA, you cannot be enrolled in a traditional FSA. However, you are eligible to enroll in a Limited Purpose Flexible Spending Account (LPFSA) along with an HSA, if offered by your employer. An LPFSA allows you to pay for eligible dental and vision expenses on a pre-tax basis, which enables you to preserve your HSA funds for other purposes, including saving for the future.
    • Can I transfer funds from an IRA into my HSA?
      You are allowed a one-time, tax-free trustee-to-trustee transfer of IRA funds into an HSA. Funds transferred from an IRA are subject to the maximum contribution limits and should be included in your total annual contribution. Also, you must remain covered under an HSA-compatible health plan for 12 months after the transfer occurs. Otherwise, the funds transferred will be treated as taxable income and subject to a 10% penalty tax.
    • Can I use my PayFlex Card® with my HSA?
      Yes, you can and should use your PayFlex Card® with your HSA. You will receive one PayFlex Card® regardless of the number of accounts that you enroll in. For example, if you enroll in an HSA and a Limited Purpose Flexible Spending Account, you will receive one PayFlex Card®. The PayFlex Card® is a MasterCard® and can be used at qualified merchants. Please remember that you are responsible for all record keeping for money spent from your HSA, so save your receipts.
    • Do I need to keep my receipts?
      You must keep all receipts showing expenditures or distributions from your HSA. There are two key reasons to keep your receipts: 1) if you exceed your deductible, you may need the receipts to send to your insurer, and 2) in case you are audited by the IRS, you need to explain your HSA expenditures.
    • Does PayFlex® set up beneficiaries for an HSA?
      An HSA is set up with the estate as the beneficiary. You may change or add beneficiaries online at any time.
    • How are distributions from an HSA taxed?
      Distributions from an HSA for the qualified medical expenses for yourself or your spouse or dependents who are covered by the High Deductible Health Plan are generally excludable from income for Federal income tax purposes if such expenses are not covered by insurance. Distributions used for purposes other than a qualified medical expense, will be subject to both income tax and a 20% penalty tax beginning in 2011, unless the person who makes a withdrawal from their HSA is age 65 or older, is disabled or deceased.
    • How can I keep track of my balance?
      Login to your HealthHub account to view your balance in the Accounts Snapshot. For more detailed account information, click on View My Account.
    • How do I know which account is being used for each transaction?
      When you use your PayFlex Card®, the merchant code determines which account the money will be deducted from, either your HSA or your Limited Purpose Flexible Spending Account (LPFSA), if you have elected one. If you elect both an HSA and an LPFSA, the LPFSA will be used for dental and vision expenses only. All other eligible healthcare expenses will be applied to your HSA. Once the LPFSA has been exhausted, all future PayFlex Card® transactions will automatically be applied to your HSA. If you do not elect a LPFSA, then all expenses will be applied toward your HSA. Remember that the purpose of the LPFSA is to help preserve your HSA funds for future use or investment opportunities.
    • How much may be contributed to an HSA?

      The maximum amount that may be contributed to an HSA for any year is established by the IRS for each tax year (depending on whether you have single coverage or family coverage). The limits established by the IRS for 2011 are $3,050 for individual coverage and $6,150 for family coverage. For the 2012 calendar year, the maximum contribution for an HSA will increase to $3,100 for individual coverage and $6,250 for family coverage. The same annual contribution limit applies regardless of whether the contributions are made by an employee, an employer, or both.

      If you become eligible and enroll in an HSA anytime between January 1 and December 1 of the current tax year, you are allowed to make the full contribution regardless of the date you actually enroll in the qualified HSA-compatible health plan.

      However, in this case you must have coverage under a qualified HSA-compatible health plan (e.g. high deductible health plan) and remain eligible for 12 months after the end of the calendar year in which you enrolled in an HSA-compatible health plan. If you are not covered by an HSA-compatible health plan for 12 months after the end of the calendar year in which you enrolled in an HSA-compatible health plan, you will be subject to income tax and a 10% penalty tax on HSA contributions for months not covered by an HSA-compatible health plan.

      The total contribution for the year can be made in one or more payments at any time up to your tax-filing deadline (without extensions.) However, if you wish to have a contribution made between January 1 and April 15 treated as a contribution for the preceding taxable year, you must provide written notification to your HSA custodian at the time such contribution is made. Otherwise, it will be treated as a contribution for the current taxable year.

    • If I am a retiree and age 65 or older, may I receive tax-free distributions from an HSA to pay my contribution to my employer’s retiree health coverage?
      After you reach age 65, you may receive tax-free distributions from an HSA to pay for your employer’s retiree health insurance coverage. Although the purchase of health insurance is generally not a qualified medical expense that can be paid or reimbursed by an HSA, the Code provides an exception for coverage for health insurance once an account beneficiary reaches age 65. This exception applies to both insured and self-insured plans.
    • If I am a retiree who is enrolled in Medicare, may I receive a tax-free distribution from an HSA to reimburse my Medicare premiums?
      Yes, this type of distribution will be tax-free. When premiums for Medicare are deducted from Social Security benefit payments, an HSA distribution to reimburse an amount equal to the Medicare premium deduction is considered a qualified medical expense.
    • Is the HSA custodian responsible for determining whether HSA distributions are used for medical expenses?
      Your custodian has no responsibility for determining whether distributions from your HSA are used for qualified medical expenses. It is your sole responsibility to determine the tax consequences of any distributions, for maintaining adequate records for tax purposes, and for paying any taxes and penalties arising as a result of any such distribution. You are encouraged to consult with your legal or tax advisor concerning any questions you may have.
    • What are my investment options?
      Your initial contributions are made to an FDIC Insured interest bearing account. After you have accumulated enough funds to meet the requirements for investing, we offer you the ability to invest your HSA contributions in an array of mutual funds options. Login to the website to review the investment options available.
    • What are the rules that apply if my HSA is transferred pursuant to a divorce decree?
      The transfer of your HSA to your spouse pursuant to a divorce decree is not considered a taxable transfer. After such transfer, the former spouse will be treated as the account holder of the HSA, but the former spouse must request the HSA custodian to transfer the account to his or her name, must provide the custodian with a certified copy of the divorce decree and property settlement or transfer agreement, and must sign appropriate documents to establish the account in that person’s name.
    • What are the tax consequences of HSA distributions following my death?
      If your spouse is the named beneficiary of your HSA, your HSA becomes the HSA of your spouse upon your death, subject to the custodian’s consent and the completion of applicable documents as required by the custodian. The surviving spouse is not required to include any amount in gross income for tax purposes as a result of your death and he or she is subject to income tax only on those distributions, which are not made for qualified medical expenses. If, at your death, your HSA passes to a named beneficiary other than your surviving spouse, the HSA ceases to be an HSA as of the date of your death, and the beneficiary is required to include the fair market value of the HSA assets as of the date of death in his or her gross income for the taxable year that includes the date of death. The includible amount is reduced by the amount in the HSA used, within one year of your death, to pay your qualified medical expenses incurred prior to death. If there is no named beneficiary of your HSA, the HSA ceases to be an HSA as of the date of your death, and the fair market value of the HSA assets as of the date of death is includible in your gross income for the year of death.
    • What expenses are eligible for tax-free distributions from my HSA?
      Distributions made for “qualified medical expenses” are generally excludable from income. For this purpose, the term “qualified medical expenses” means amounts paid for the medical care, as defined in Section 213(d) of the Code, for yourself, your spouse, or your dependents, but only if the expenses are not covered by insurance. This includes amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease or for the purpose of affecting any structure or function of the body, as well as for transportation primarily for and essential to such care. If you incur healthcare expenses before your HSA is established, those expenses will not be considered qualified medical expenses. In addition, qualified medical expenses do not include insurance premiums other than premiums for long-term care insurance, premiums on a health plan during any period of continuation coverage required by Federal law (e.g., “COBRA” coverage), or premiums for health care coverage while an individual receives unemployment compensation. For more information, please refer to IRS Publication 502.
    • What happens to my HSA upon my death?
      You have the right at any time to designate one or more beneficiaries to whom distribution of your HSA will be made upon your death. You also have the right to revoke a prior beneficiary designation and, if desired, designate different individuals as beneficiaries. You should understand that in certain states, your spouse’s consent may be necessary if you wish to name a person other than or in addition to your spouse as beneficiary or to change an existing beneficiary designation. You should consult with your attorney before making such a beneficiary designation.
    • What happens when I terminate employment?
      If you change employers or leave the work force, the HSA stays with you rather than with your former employer. The account information will remain the same, however new fees may apply for these independent accounts.
    • What is a Health Savings Account?
      A Health Savings Account (“HSA”) is a tax-advantaged healthcare account created for the purpose of saving and paying for qualified medical expenses now and in the future. If you are enrolled in an HSA-compatible health plan, such as a high deductible health plan (HDHP), you can enroll in an HSA. The maximum HSA contribution is established by the IRS and is subject to change annually. The funds contributed to an HSA will rollover and accumulate year to year if not used. In addition, an HSA is portable, which means if you change employers or leave the work force, the HSA stays with you. Finally, an HSA does not require you to submit documentation to substantiate your transactions; however, you should keep your receipts in the event of an IRS audit.
    • What is an “excess contribution” and what happens if this occurs?
      A contribution made by you or your employer to an HSA that exceeds the amount allowed by law, or which is made during any year when you are not eligible to contribute, is called an “excess contribution.” Excess contributions including any income earned on the excess contributions should be removed from your HSA prior to filing your federal income tax return for that tax year. Excess contributions that are not removed will be subject to a 6% penalty tax each year the excess remains in the account. Please consult your tax advisor or accountant to determine the proper handling of excess contributions, since this may vary based on whether you or your employer are responsible for the excess, which tax year the excess was discovered and whether earnings were involved.
    • What is the allowable “catch-up” contribution amount?

      The maximum “catch-up” contribution amount for the 2011 and 2012 tax year is $1,000 per tax year. Each spouse (age 55 or older) can contribute up to $1,000 into his or her own HSA. If you did not have an HSA-compatible health plan, such as a high deductible health plan (HDHP), for the full year, you must pro-rate your “catch-up” contribution for the number of full months you were “eligible” (i.e., had HDHP coverage). If you had an HSA-compatible health plan for the entire year, you can deposit the entire “catch-up” amount starting with the year you turn 55, regardless of when you turn 55 during the year.

      In the year you enroll in Medicare, you must pro-rate your “catch-up” contribution for the number of months you had an HSA-compatible coverage, prior to the month your Medicare enrollment is effective. You can delay enrollment in Medicare Part A only if you delay taking Social Security. You can delay taking Social Security up until age 70 and one half years old.

      Once either spouse enrolls in Medicare, that spouse can no longer contribute any funds, including “catch-up” amounts, to their HSA. If you are not enrolled in Medicare, you can contribute to your HSA and continue to make “catch-up” contributions.

    • What is the tax treatment of an eligible individual’s HSA contributions?
      When you make an eligible contribution to an HSA, the amount of your contribution up to the maximum contribution limit is deductible in computing your adjusted gross income provided the contribution is not made through pre-tax payroll contributions. This means that your contributions are deductible whether or not you itemize deductions. In addition, any person who may be claimed as a dependent on another taxpayer’s return may not claim a deduction for a contribution to an HSA. A special rule applies to certain married individuals. If either spouse has family coverage under an HSA-compatible health plan, both spouses will be treated as having family coverage. The amount allowable as a deduction after application of this rule shall be divided equally between the spouses unless they agree on a different division. If you are contributing view pre-tax payroll contributions, you have already received the tax benefit and you do not deduct these amounts on your tax return.
    • What kind of health plan makes someone eligible for an HSA?
      An HSA-compatible health plan, sometimes referred to as a high deductible health plan, or an "HDHP" is a health plan that: (1) has an annual deductible of at least $1,200 for individual (self-only) coverage or (2) has an annual deductible of at least $2,400 for family (more than one individual) coverage. In addition, the 2011 annual out-of-pocket expenses required to be paid under the plan cannot exceed $5,950 for individual coverage and $11,900 for family coverage. For the 2012 calendar year, the deductibles remain the same as above but the annual maximum out-of-pocket amount will be $6050 for individual coverage and $12,100 for family coverage. The maximum out-of-pocket limit includes deductibles, co-payments, and other amounts the participant must pay for covered benefits, but does not include premiums or non-covered expenses by the health plan. (The deductibles and maximum out-of-pocket dollar amounts are both subject to change for later tax years.)
    • What other types of health coverage can I maintain without losing eligibility to contribute to an HSA?
      You remain eligible to contribute to an HSA if, in addition to an HSA-compatible health plan, you have any one or more of the following: insurance under which substantially all of the coverage relates to liabilities from workers’ compensation laws, torts, or ownership or use of property (such as automobile insurance); insurance for a specified disease or illness; insurance paying a fixed amount per day (or other period) of hospitalization; or coverage (whether through insurance or otherwise) for accidents, disability, dental care, vision care, or long-term care. You may also have coverage under an Employee Assistance Program (“EAP”), and you may have a discount card that enables you to obtain discounts for health care services or products at managed care market rates.
    • When am I subject to the 20% penalty tax?
      If you use your HSA funds for non-qualified medical expenses, those funds will be applied to your gross income and taxed accordingly. In addition, a penalty tax is applied when using your HSA funds for non-qualified medical expenses. The penalty tax does not apply to distributions made after your death, disability or attainment of age 65.
    • When can I receive distributions from an HSA?
      You can take a distribution from your HSA at any time. A transfer of funds from your HSA to another investment option made available through us is not considered a “distribution,” and remains part of your HSA custodial account.
    • When is the deadline for making contributions to an HSA for any particular year?
      You may make HSA contributions for a particular year no later than the deadline (without extensions) for filing your federal income tax return for that year. For calendar year taxpayers, this is generally April 15 following the year for which the contributions were made. However, your HSA custodian will treat any contribution made between January 1 and April 15 as a contribution for the current taxable year unless you provide written notice to the HSA custodian at the time of such contribution.
    • Who is eligible for an HSA?
      An eligible individual is one who (i) is covered under an HSA-compatible health plan as of the first day of the month, (ii) is not covered by any other health plan unless it is another HSA-compatible health plan, (iii) is Medicare eligible but not enrolled in Medicare, and (iv) may not be claimed as a dependent on another person’s tax return.
    • Who may contribute to an HSA?
      Any person (an eligible individual, an employer, a family member, or any other person) may make contributions to an HSA on behalf of an eligible individual.
    • Will I receive a statement of my account activity?
      Yes, you will receive statements showing your account activity. You may elect to receive your statements electronically or via US Mail.
  • My PayFlex Card®
    • Can I buy over-the-counter (OTC) items with the card?

      Certain OTC medicines and supplies are eligible if the merchant location has implemented the inventory information approval system as required by the IRS. For a listing of eligible expenses, visit My HealthHub Resources and click on Planning Tools.

      After December 31, 2010, your PayFlex Card® cannot be used to purchase certain OTC drugs and medicines. If you have a prescription from your physician for your OTC drug or medicine you may purchase with another form of payment and submit a claim for reimbursement.

    • Can I use my PayFlex Card® for dental expenses?
      Yes, you can use the PayFlex Card® for dental expenses if allowed by your employer. However, you can only use it for the amount of the dental expense that is not covered by insurance. According to the IRS, expenses paid by another source, such as insurance, cannot be reimbursed through your healthcare account as well. It is best to wait until you receive the final amount from your insurance provider stating your financial responsibility to pay your provider. Using the PayFlex Card® to pay for your dental expenses before your insurance provider has determined the amount of your financial responsibility could result in an overpayment from your healthcare account.

      For example: If your dentist uses an "estimated" or "pending" amount to determine your expense, instead of the actual amount as determined by your insurance provider, and you pay that amount with the PayFlex Card®, the dentist may have overcharged your account, resulting in an overpayment. This happens if your healthcare account paid for a portion of your dental charges that might also be paid by insurance. This will put your healthcare account in an “overpayment status”. To resolve an overpayment, you must send a check to PayFlex® for the overpayment amount OR submit a claim for another eligible expense that was purchased with a form of payment other than your PayFlex Card®.
    • Can I use my PayFlex Card® for online purchases?
      Yes, you can use your card to purchase eligible expenses online. Through HealthHub’s Consumer Center, you can buy items such as glasses, contacts, prescription drugs, durable medical equipment and eligible over-the-counter items using your PayFlex Card®. If an item is not identified as “FSA eligible” you will need to use a form of payment other than your PayFlex Card®. For a listing of eligible expenses, visit My HealthHub Resources and click on Planning Tools.
    • Do I need to submit claim forms when I use my PayFlex Card®?
      You do not need to submit a claim when using the card; however, documentation of your expenses may be required in order to meet IRS guidelines. Therefore, you should keep copies of all itemized receipts* (not just your credit card receipt) and Explanation of Benefits (EOB) for each purchase. You must comply with IRS guidelines by using the card only for qualifying expenses, and providing appropriate documentation upon request.
    • Do I still need to save my receipts?
      Yes, you should continue to save your receipts in case you are required to verify that you used your PayFlex Card® for an eligible expense.
    • How do I access my account information & view my PayFlex Card® transactions online?
      Login to your HealthHub account and select Financial Center from the top navigation bar. Then select an account from the drop down menu to view account information and card transactions.
    • How do I report a lost or stolen card?
      Contact us as soon as possible to report a lost or stolen card. If the loss of a card is reported within 30 days, you are not liable for any fraudulent charges.
    • How does my PayFlex Card® work?

      As you incur eligible healthcare expenses, you can use your PayFlex Card® as a form of payment. All you have to do is swipe your card and select “Credit.” If you are paying for services or items from a healthcare-related merchant or one that has implemented an inventory information approval system, your transaction will be automatically approved at the point of sale. You should always keep your itemized receipts and Explanation of Benefits (EOB) in the event that you need to provide them to the IRS.

      If you purchase eligible healthcare expenses along with non-qualifying items, be sure to ask the merchant to ring up eligible items separately so that you can use your PayFlex Card®.

      Your card is valid for a five-year period. Each year you enroll, the card will reflect that plan year election amount(s). The card can only be used for expenses incurred during the plan year, unless your employer has elected the grace period, allowing an extra 2 ½ month period to utilize your FSA dollars.

    • How does my PayFlex Card® work?

      As you incur eligible healthcare expenses, you can use your PayFlex Card® as a form of payment. All you have to do is swipe your card and select “Credit.” If you are paying for services or items from a healthcare-related merchant or one that has implemented an inventory information approval system, your transaction will be automatically approved at the point of sale. You should always keep your itemized receipts and Explanation of Benefits (EOB) in the event that you need to provide them to the IRS.

      If you purchase eligible healthcare expenses along with non-qualifying items, be sure to ask the merchant to ring up eligible items separately so that you can use your PayFlex Card®.

      Your card is valid for a five-year period. Each year you enroll, the card will reflect that plan year election amount(s).

    • I just received my PayFlex Card® in the mail. Do I have to use the card for all of my healthcare expenses?
      No, you do not need to use your card for all healthcare expenses. You can always use another form of payment for your expenses and submit a claim for reimbursement.
    • If my employer offers a grace period, may I use my PayFlex Card® for transactions incurred during the grace period?
      If you have elected to participate in the program for the next plan year, you may use your card to pay for your eligible expenses during the grace period. Expenses incurred during the grace period will be applied toward your prior year’s balance first helping to “use up” your prior year’s balance. Once the prior plan year’s balance has been exhausted, the remaining claims will be applied toward the current plan year.

      If you did not elect to participate in the program for the next plan year, your PayFlex Card® will expire at the end of the plan year in which you participated. In this case, you will need to use another form of payment for your grace period purchases and then submit your grace period claims either online, via fax or mail for reimbursement.

    • Should I select “debit” or “credit” when using my PayFlex Card®?
      Always select the “credit” option when using your PayFlex Card®.
    • What are the benefits of using a PayFlex Card®?
      There are four key benefits:
      • Immediate payment of your expenses from your healthcare account
      • Increased personal cash flow
      • Reduced paper claim filing
      • Ease of use of your pre-tax funds
    • What happens if I have a $1,000 balance in my FSA and I use my PayFlex Card® to pay for a $1,500 healthcare expense?
      Transactions exceeding your available balance will be denied. However, in this case you could ask the merchant to charge your PayFlex Card® for the amount available in your FSA ($1,000) and pay the remaining balance ($500) with another form of payment.
    • What if the merchant has an inventory information approval system and my card is still denied?
      If your card is still being denied, it may be due to one of the following reasons:
      • Your balance does not cover the entire cost of your eligible expense AND your merchant may not allow you to use your PayFlex Card® for just a portion of the expense based on your available balance.
      • Your card may be temporarily inactive. We may need additional documentation from you to verify that you used your card for an eligible expense. Login to your HealthHub account to view your card status and find out if you have outstanding transactions requiring documentation. If you have transactions requiring documentation, you can upload your documentation online.
    • What is a PayFlex Card®?
      Your PayFlex Card® is accepted at all healthcare-related merchants, such as physician and dentist offices, hospitals, pharmacies, hearing and vision care providers. Your card will also be accepted at discount stores and grocery stores that have implemented an inventory information approval system (IIAS). All qualified merchants must accept MasterCard® in order for your card to work.
    • What is a PayFlex Card®?
      Your PayFlex Card® is accepted at all healthcare-related merchants, such as physician and dentist offices, hospitals, pharmacies, hearing and vision care providers. All qualified merchants must accept MasterCard® in order for your card to work.
    • What is an inventory information approval system (IIAS)?
      An inventory information approval system (IIAS) is a system that identifies whether a product or service purchased with a healthcare card is an eligible or ineligible healthcare expense according to IRS 213(d). An IIAS is required at merchants such as drug stores, pharmacies, grocery stores, hospitals, etc. in order for healthcare cards to be accepted.
    • What should I do if my card is denied?
      If your card is denied because the merchant does not have an inventory information approval system, you have two options:

      OPTION #1: Use another form of payment to purchase your healthcare item and submit a claim for reimbursement.

      OPTION #2: Purchase from another merchant.

    • What should I do if my card is denied?
      If your card is denied because the merchant does not have an inventory information approval system, you have two options:

      OPTION #1: Use another form of payment to purchase your healthcare item and submit a claim for reimbursement.

      OPTION #2: Purchase from another merchant. A listing of merchants accepting the card is available using the links below.

      Listing of merchants with IRS-approved IIAS
      Listing of drug stores and pharmacies
    • What should I do if my drug store or pharmacy chose not to implement an inventory information approval system (IIAS)?
      If your drug store or pharmacy has not implemented an IIAS, you can continue to purchase eligible healthcare expenses from that location with another form of payment and submit a claim for reimbursement.
    • What should I do if my provider does not accept MasterCard®?
      If your provider does not accept MasterCard®, you will be required to use another form of payment and submit a claim for reimbursement.
    • When documentation is requested for my dental expenses, what should I provide?
      Acceptable documentation consists of one (please do not send both) 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.

      *Please note that a cancelled check or credit card receipt alone is not acceptable documentation.

      NOTE: If the documentation you provide indicates "estimated" or "pending" insurance payment, PayFlex® will not be able to approve the card transaction until final documentation is received. The final documentation, which is generally your insurance company's EOB, must show your financial responsibility.
    • Where can I use my PayFlex Card®?

      Your PayFlex Card® is accepted at all healthcare-related merchants, such as physician and dentist offices, hospitals, pharmacies, hearing and vision care providers.

    • Where can I use my PayFlex Card®?

      Your PayFlex Card® is accepted at all healthcare-related merchants, such as physician and dentist offices, hospitals, pharmacies, hearing and vision care providers. Your card will also be accepted at discount stores and grocery stores that have implemented an inventory information approval system (IIAS). All qualified merchants must accept MasterCard® in order for your card to work.

      View a listing of merchants that accept your PayFlex Card®.

    • Why did I receive a Request for Documentation letter for my dental expense?
      The PayFlex Card®TM is set up to approve copayments that match your employers' dental plan. Most likely you received this letter because your expense did not match your employer's dental co-pay. When an expense does not match your co-pay, IRS requires that PayFlex® review your documentation to verify that the dental expenses are eligible. There are some dental expenses that fall under the ineligible category such as teeth whitening and dental veneers. Therefore, PayFlex® is required to make sure that you are not using your healthcare dollars for ineligible expenses.

      Please note, that although your expenses may be clearly associated to a dentist, there still may be instances where you will need to provide an itemized statement or Explanation of Benefits (EOB) to verify that you used your card for an eligible dental expense. We recommend that you keep all itemized receipts and EOBs.
    • Why did I receive a Request for Documentation letter?
      Per IRS requirements, you are required to verify that you used your PayFlex Card® for eligible expenses during the plan year. You received a Request for Documentation letter because we need to verify that the transactions listed on your letter were eligible expenses. To keep your card active, please respond to this letter promptly by providing the requested documentation. You can respond online by uploading your documentation. To get started, login to your HealthHub account and click on Learn More next to the claim substantiation alert message.
    • Why isn’t my PayFlex Card® working?
      If your card is not working, it could be due to one of the following reasons:
      • Your card is temporarily inactivated – we have not received requested documentation to approve your expense.
      • You have insufficient funds – your eligible expense is greater than your remaining balance.
      • There is a problem with the merchant – for some reason, the merchant is not recognizing your expense as an eligible expense.
      • You are using an invalid merchant – the merchant does not accept MasterCard® or has not implemented an inventory information approval system.
    • Will I receive a statement of my PayFlex Card® transactions?
      A statement including your PayFlex Card® transactions is only available online. Login to your HealthHub account and select Financial Center on the top navigation bar. Then select an account from the drop down menu to view your recent transactions.
  • HH - Commuter Benefits (online ordering platform)
    • Can I cancel my pass at any time during the month?
      Ordered passes and recurring order passes may be cancelled before the cycle close date. During the order cycle, transit orders placed are listed under the “pending” tab of the transit website.
    • Can I order the exact pass I use now?
      We offer more than 10,000 different types of tickets and passes and most likely, we have exactly what meets your transit or parking needs. If you cannot find your provider, simply select the “click here” link located on the transit order screen. You can provide us with your transit pass information and you will be notified within 10 business days on the status of your request.
    • Do I have to go online every month to purchase my transit pass?
      When you make your online purchase you have the option to schedule it as an automatically recurring transaction. If you choose this option, your purchase will be automatically placed monthly so you do not need to go back online unless you need to make a change or cancel your recurring purchase for a particular month.
    • Do I need to submit any receipts for transit passes?
      You do not need to submit any receipts when you order your transit passes online.
    • How can I save money with this program?
      If you enroll in a Commuter Benefits online program, you are not required to pay income, Social Security or FICA taxes on money that is used to pay for commuting expenses. Therefore, assuming a combined tax rate of 30% and an election of $125/month for transit expenses, you can save more than $450 per year. If you elect the maximum of $240/month for parking, you can save another $864 per year on parking expenses. That’s like getting four months of commuting for free!
    • How do I purchase my transit pass online?
      Login to your HealthHub account and select Commuter Benefits on the left navigation bar to get started.
    • How do I submit a parking order online?
      There are three parking options available to you online. You may choose Monthly Direct Pay, Commuter Checks for Parking or Cash Reimbursement.
    • What are the monthly pre-tax limits?
      For 2012, the monthly pre-tax limit for parking expenses is $240 and the combined limit for transit and vanpool is also $125. These limits are set by the Federal government and are generally adjusted annually. If offered by your employer, you are allowed to participate in both transit and parking for a total pre-tax limit of $365.
    • What do I do if my address changes?
      If you have a change of address, please provide your new address to your employer immediately. HealthHub only accepts address changes from your employer. This address is where your pass will be mailed. You cannot change your mailing address online or by calling our call center.
    • What expenses are eligible for this pre-tax benefit?
      Public transportation, vanpools, carpools or commuter highway vehicles, as well as parking at or near your place of employment are all eligible pre-tax expenses. In addition, parking at a location from where you commute to work by public transit, vanpool or carpool, is also a qualified expense.

      • If you carpool, only one member of the carpool can claim the parking expense on a pre-tax basis. It does not include parking at or near your residence.
      • If you vanpool, the van must be primarily used for commuting (at least 80% of the time), with a seating capacity of at least six adults excluding the driver and must be at least half full. A van that you or one of the other riders owns or operates as your personal vehicle is not a vanpool.
      • Ineligible expenses include mileage, tolls and fuel, business travel and other reimbursed travel expenses.

    • What happens if I lose my pass?
      Passes are non-refundable. You are allowed one non-delivered pass refund per calendar year assuming the pass was mailed to the correct address, but did not arrive. Instructions are located under the “help” link.
    • What happens if my pass doesn't arrive in the mail?
      If your pass does not arrive in the mail and you have provided a correct mailing address, login to your HealthHub account and click on Commuter Benefits on the left-hand navigation bar. Then follow the non-delivered pass refund instructions under Help.
    • What if I don’t have a monthly parking location that is set-up to take payments directly from HealthHub each month?
      If your parking provider cannot take payments directly from HealthHub, you can still participate in the pre-tax benefit by enrolling in the Cash Reimbursement program. After you have paid for your parking and obtained a receipt, simply submit your claim online for reimbursement.
    • What if my mailing address is outside of the US?
      You must have a US mailing address to take advantage of the pre-tax commuter benefit program. The main reason for this is that passes are time sensitive and are sent by the bulk mailing system which does not accommodate the additional postage and mailing time required to ship orders to foreign mailing addresses (including addresses in Puerto Rico, Canada and Mexico).
    • What is the Commuter Benefits online program?
      This program provides you with an online ordering system for transportation and parking. By using this benefit, you can save on your income, Social Security and FICA taxes by paying for your commuting expenses with pre-tax dollars up to the IRS limit. Orders are made online, the purchase price is deducted from your paycheck and your passes are mailed directly to your home. Passes can be ordered for any amount. Any orders above the pre-tax limit will be withheld from your paycheck on a post-tax basis.

      Note:If you have a Commuter Benefits program where you contribute to a Transportation Spending Account and submit receipts for reimbursement, click here to be directed to our Commuter Benefits (reimbursement account solution) FAQs.

    • When can I purchase my transit pass or monthly parking online?
      Monthly purchase cycles vary by employer and can run from the 21st of one month until the 10th of the following month.
    • When will I receive my transit pass?
      Your transit pass will arrive at your home address before the 1st of the benefit month. Funds will be loaded and available on the Stored Value Transit Cards (e.g. Chicago Card, MetoCard, etc. by 12:01 am on the 1st of the benefit month.
    • When will my parking location receive my monthly payment?
      Parking garages and lots are paid at the end of each month for the following months’ use. In rare instances where payment cannot be made to the lot directly, you will receive the payment directly which can then be given to the parking provider.
  • 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.
    • 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 Disney approved Qualifying Life Event or status change.
    • Do I have to enroll in Disney’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.
    • 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 healthcare expenses and/or dependent care expenses during the plan year.
      2. Decide how much you wish to set aside into your Healthcare FSA and/or your Dependent Day 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 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 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 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.
    • 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 $5000 per household per plan year.
    • 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 My HealthHub Resources and click Planning Tools. For more information, please refer to IRS Publication 503.
    • What happens if I leave Disney or my employment is terminated?
      Upon termination of employment, you may continue to submit healthcare claims incurred prior to termination and up to the amount of the balance in your account. Dependent day care claims can be submitted to the end of the calendar year up to the balance in your account
    • What happens if I leave my company or my employment is terminated?
      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 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 happens to the funds left in my account at the end of the plan year?
      Any funds left in your account at the end of the year are forfeited. 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 happens to the funds left in my account at the end of the plan year?
      Since Disney has elected to include a "grace period" within your plan, you have an additional 2½ months after the end of your plan year (until the following March 15) to use your FSA funds. Otherwise, any funds left in your account at the end of the year are forfeited. 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), also known as a Reimbursement Account, provides a tax-advantaged way to pay for eligible out-of-pocket healthcare 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 Healthcare FSA, also known as a Health Care Reimbursement Account (HCRA), 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, also known as a Dependent Care Reimbursement Account (DCRA), 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 a Flexible Spending Account?
      A Flexible Spending Account (FSA) provides a tax-advantaged way to pay for eligible out-of-pocket healthcare 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 Healthcare 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.

      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 a Flexible Spending Account?
      A Flexible Spending Account (FSA) provides a tax-advantaged way to pay for eligible out-of-pocket healthcare 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 Healthcare 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.
  • HH - Commuter Benefits (reimbursement account solution)
    • Can I enroll at any time?
      You can enroll at any time during the plan year to begin participation starting the beginning of the next month. Please check with your Human Resources/Benefits Department for additional details.
    • Do I need to keep my receipts?
      Yes, each time you pay for work-related parking and/or transportation, you must keep the receipt of the expense to be reimbursed. There may be times where a receipt is not provided for your parking & transit expenses. In this case, submit a claim and note that no receipt was provided.
    • How do I file a claim?
      Login to your HealthHub account and select File a Claim to get started.
    • How does a reimbursement account work with Commuter Benefits?
      A reimbursement account for Commuter Benefits, also referred to as a Transportation Spending Account (TSA), allows you to put aside money on a pre-tax basis to pay for work-related commuting and parking expenses. It is an employer sponsored plan that is endorsed by Section 132 of the Internal Revenue Code. If offered by your employer, it may consist of two separate benefits, parking and transportation. If your employer offers this benefit and you elect to participate, you will elect an annual contribution which will be taken out of your paycheck on a pre-tax basis in equal amounts. This money will be available to pay for eligible work-related transit and parking expenses based on claims submitted.

      • For 2012, the maximum election for parking is $240 per month and the maximum election for transit is $125 per month. A commuter who incurs both transportation and parking expenses is eligible to contribute a total of $365.00 per month on a pre-tax basis with up to $240/month applied toward parking and $125/month applied towards transit.
      • You can submit claims for parking and qualified transit expenses incurred during the calendar year and will be reimbursed up to the limits allowed by the IRS on a monthly basis.
      • Reimbursements for your parking and/or transit expenses can be deposited directly into your bank account.

    • How does paying for my commute with pre-tax dollars save me money?
      The program allows you to pay for your commuting expenses before Federal, state and local taxes are taken out of your paycheck by your employer. Paying with pre-tax dollars decreases your taxable income and, therefore, you pay less in taxes.
    • How often can I change my election?
      Typically you may change your election on a monthly basis. Please check with your Human Resources/Benefits Department for additional details.
    • If I couldn’t use my PayFlex Card® to purchase my transit pass, can I submit a claim to PayFlex® for reimbursement?
      If your employer allows a cash reimbursement option, then you may submit a claim to PayFlex® for reimbursement.
    • If I do not use the money in my transportation account, will I lose it?
      This depends on how your Employer’s plan is set up. Please check with your Human Resources/Benefits Department for additional details on your specific plan.
    • May I use my PayFlex Card® for transit expenses?
      If your employer offers the PayFlex Card® for transit expenses and you have elected to participate in the transportation spending account, then you may use your PayFlex Card® to pay for your transit passes/vouchers.
    • What commuting expenses are eligible for this pre-tax benefit?
      Eligible transportation services include subways, buses, ferries, commuter rail, carpools and vanpools.

      • Eligible parking expenses include parking at work or near a location from which you commute to work by mass transit, vanpooling in a commuter highway vehicle, carpool or by other means.
      • If you carpool, only one member of the carpool can claim the parking expense on a pre-tax basis. This does not include parking at or near your residence.
      • If you vanpool, the van must be primarily used for commuting (at least 80% of the time), with a seating capacity of at least six adults excluding the driver and must be at least half full. A van that you or one of the other riders owns or operates as your personal vehicle is not a vanpool and is not eligible.
      • Ineligible expenses include mileage, tolls and fuel, business travel and other reimbursed travel expenses.

    • What is considered a valid receipt?
      A valid receipt should have the merchant name, date, amount of expense and a description of the purchase for a transportation pass or parking.
    • What should I do if I try to use my PayFlex Card® and the transaction is denied?
      If you try to use your PayFlex Card® to purchase a transit pass and your transaction is denied, please make sure that you have confirmed your available balance and that you have enough funds for the purchase.
  • Healthcare FSA Claim Tips
    • Can I pay my spouse's health insurance premiums through my Healthcare 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 Healthcare Flexible Spending Accounts (FSAs).
    • How is orthodontia reimbursed under an FSA?
      The IRS recognizes that orthodontia treatment is different from any other type of healthcare expense. To get reimbursed for orthodontia expenses you are required to submit one of the following:

      • Coupon Payment Option – You can submit an itemized statement of your orthodontia expenses as the service is provided. Submit this documentation with a completed claim form for reimbursement.
      • Monthly Payment Option (Auto Pay) – To set up Auto Pay, download a claim form via My HealthHub Resources, complete all required fields and make sure to check the box for Automatic Monthly Reimbursement for Orthodontia expenses. You must also include a copy of your ortho contract/agreement* with your first claim. Once the claim has been processed, PayFlex® will automatically reimburse you each month, according to the agreement. This eliminates the need for you to submit a claim form for each visit and allows expenses to be paid monthly for the length of the contract, as long as you are enrolled in an FSA and have funds available in your account.

        *You can obtain a contract/payment agreement from the orthodontist with the following information:
        • Patient name
        • Date the service begins
        • Length of service
        • Charges for the initial banding work
        • Dollar amount charged each month

        AutoPay Reminders:
        • If you enroll in AutoPay, the PayFlex Card® cannot be used to pay for orthodontia expenses.
        • Reimbursements will be issued on a monthly basis near the due date stated on your orthodontia contract agreement.
      • Total Payment Option – If you paid the full amount when the orthodontia treatment began, you can get reimbursed for the amount you paid for the treatment, minus the amount covered by your dental insurance. PayFlex® will reimburse you, up to your FSA election amount, minus any previous FSA reimbursements. If you have already submitted other claims, make sure to check your FSA balance online to confirm the amount you have available to cover your orthodontia treatment.

        To get reimbursed, simply send a copy of your paid receipt and completed claim form to PayFlex®, along with an itemized statement with the following information:
        • Provider name
        • Patient name
        • Date treatment started
        • Amount of expense
        • Amount insurance will pay
        Note: If you choose the total payment option, please remember a paid receipt must be submitted to PayFlex® and can only be submitted once for reimbursement.

      Orthodontia Example: Full payment is made on the first orthodontist visit
      Let’s say you participate in a healthcare Flexible Spending Account (FSA) in 2011 and 2012. In October 2011, you sign an agreement with an orthodontist for your son. During the first visit (November 2011), your son is X-rayed and fitted for braces. On the second visit (December 2011), 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 $3,000 on the date of the first visit, which you pay in 2011.

      Can I be reimbursed the full $3,000 from my 2011 healthcare FSA?
      Yes, provided you have at least $3,000 available in your FSA. Although your son did not receive all of the care in 2011, the IRS regulations allow the healthcare FSA to reimburse you for the entire $3,000 as a 2011 expense.

      What if I do not have the full $3,000 remaining in my 2011 healthcare FSA?
      If you paid the entire orthodontia bill of $3,000 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 2011 and the orthodontist is charging you $3,000. On January 15, 2012, you decided to pay the lump sum amount. Since you paid for the expense during the grace period, you would be reimbursed from the 2011 FSA balance first (if money is still available) and then from the 2012 FSA balance. (Note: the amount you are reimbursed cannot exceed the amount paid to the orthodontist or the total amount of your 2011 and 2012 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.
    • How is orthodontia reimbursed under an FSA?
      The IRS recognizes that orthodontia treatment is different from any other type of healthcare expense. To get reimbursed for orthodontia expenses you are required to submit one of the following:

      • Coupon Payment Option – You can submit an itemized statement of your orthodontia expenses as the service is provided. Submit this documentation with a completed claim form for reimbursement.
      • Monthly Payment Option (Auto Pay) – To set up Auto Pay, download a claim form via My HealthHub Resources, complete all required fields and make sure to check the box for Automatic Monthly Reimbursement for Orthodontia expenses. You must also include a copy of your ortho contract/agreement* with your first claim. Once the claim has been processed, PayFlex® will automatically reimburse you each month, according to the agreement. This eliminates the need for you to submit a claim form for each visit and allows expenses to be paid monthly for the length of the contract, as long as you are enrolled in an FSA and have funds available in your account.

        • Patient name
        • Date the service begins
        • Length of service
        • Charges for the initial banding work
        • Dollar amount charged each month

        Submit your agreement with your first claim and PayFlex® will automatically reimburse you each month, according to the agreement. This eliminates the need for you to submit a claim form for each visit and allows expenses to be paid monthly/quarterly for the length of the contract. You will need to send a new claim form with your contract agreement at the beginning of the next plan year if you wish to continue reimbursements.


        Auto Pay Reminder:
        • Reimbursements will be issued on a monthly basis near the due date stated on your orthodontia contract agreement.
      • Total Payment Option – If you paid the full amount when the orthodontia treatment began, you can get reimbursed for the amount you paid for the treatment, minus the amount covered by your dental insurance. PayFlex® will reimburse you up to your FSA election amount, minus any previous FSA reimbursements. If you have already submitted other claims, make sure to check your FSA balance online to confirm the amount you have available to cover your orthodontia treatment.

        To get reimbursed, simply send a copy of your paid receipt and completed claim form to PayFlex®, along with an itemized statement with the following information:
        • Provider name
        • Patient name
        • Date treatment started
        • Amount of expense
        • Amount insurance will pay
        Note: If you choose the total payment option, please remember a paid receipt must be submitted to PayFlex® and can only be submitted once for reimbursement.
      • Orthodontia Example: Full payment is made on the first orthodontist visit
        Let’s say you participate in a healthcare Flexible Spending Account (FSA) in 2011 and 2012. In October 2011, you sign an agreement with an orthodontist for your son. During the first visit (November 2011), your son is X-rayed and fitted for braces. On the second visit (December 2011), 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 $3,000 on the date of the first visit, which you pay in 2011

        Can I be reimbursed the full $3,000 from my 2011 healthcare FSA?
        Yes, provided you have at least $3,000 available in your FSA. Although your son did not receive all of the care in 2011, the IRS regulations allow the healthcare FSA to reimburse you for the entire $3,000 as a 2011 expense.

        What if I do not have the full $3,000 remaining in my 2011 healthcare FSA?
        If you paid the entire orthodontia bill of $3,000 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 2011 and the orthodontist is charging you $3,000. On January 15, 2012, you decided to pay the lump sum amount. Since you paid for the expense during the grace period, you would be reimbursed from the 2011 FSA balance first (if money is still available) and then from the 2012 FSA balance. (Note: the amount you are reimbursed cannot exceed the amount paid to the orthodontist or the total amount of your 2011 and 2012 FSA balances.)

      • Orthodontia Example: Orthodontia treatments provided over two plan years
        When treatment is spread over two plan 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.

      • Orthodontia Example: Orthodontia expense is greater than your available FSA balance
        You incure an orthodontia expense in December 2011 totaling $2000 and you pay the full amount in December.
        • 2011 FSA balance = $500
        • 2012 FSA balance = $2000

        If you submit a claim in December 2011 and request reimbursement for the full amount of the $2000 expense, you would only be reimbursed $500. The remaining $1500 can be reimbursed from 2012 FSA funds as long as you provide documentation stating the orthodontia services are ongoing in 2012.

        NOTE: Even though you have not received all orthodontic services, IRS guidelines state that orthodontia services are deemed incurred at the time of payment.
    • How is orthodontia reimbursed under an FSA?
      The IRS recognizes that orthodontia treatment is different from any other type of healthcare expense. To get reimbursed for orthodontia expenses you are required to submit one of the following:

      • Coupon Payment Option – You can submit an itemized statement of your orthodontia expenses as the service is provided. Submit this documentation with a completed claim form for reimbursement.
      • Monthly Payment Option (Auto Pay) – To set up Auto Pay, download a claim form via My HealthHub Resources, complete all required fields and make sure to check the box for Automatic Monthly Reimbursement for Orthodontia expenses. You must also include a copy of your ortho contract/agreement* with your first claim. Once the claim has been processed, PayFlex® will automatically reimburse you each month, according to the agreement. This eliminates the need for you to submit a claim form for each visit and allows expenses to be paid monthly for the length of the contract, as long as you are enrolled in an FSA and have funds available in your account.

        *You can obtain a contract/payment agreement from the orthodontist with the following information:
        • Patient name
        • Date the service begins
        • Length of service
        • Charges for the initial banding work
        • Dollar amount charged each month

        AutoPay Reminders:
        • If you enroll in AutoPay, the PayFlex Card® cannot be used to pay for orthodontia expenses.
        • Reimbursements will be issued on a monthly basis near the due date stated on your orthodontia contract agreement.
      • Total Payment Option – If you paid the full amount when the orthodontia treatment began, you can get reimbursed for the amount you paid for the treatment, minus the amount covered by your dental insurance. PayFlex® will reimburse you, up to your FSA election amount, minus any previous FSA reimbursements. If you have already submitted other claims, make sure to check your FSA balance online to confirm the amount you have available to cover your orthodontia treatment.

        To get reimbursed, simply send a copy of your paid receipt and completed claim form to PayFlex®, along with an itemized statement with the following information:
        • Provider name
        • Patient name
        • Date treatment started
        • Amount of expense
        • Amount insurance will pay
        Note: If you choose the total payment option, please remember a paid receipt must be submitted to PayFlex® and can only be submitted once for reimbursement.

      Orthodontia Example: Full payment is made on the first orthodontist visit
      Let’s say you participate in a healthcare Flexible Spending Account (FSA) in 2011 and 2012. In October 2011, you sign an agreement with an orthodontist for your son. During the first visit (November 2011), your son is X-rayed and fitted for braces. On the second visit (December 2011), 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 $3,000 on the date of the first visit, which you pay in 2011.

      Can I be reimbursed the full $3,000 from my 2011 healthcare FSA?
      Yes, provided you have at least $3,000 available in your FSA. Although your son did not receive all of the care in 2011, the IRS regulations allow the healthcare FSA to reimburse you for the entire $3,000 as a 2011 expense.

      What if I do not have the full $3,000 remaining in my 2011 healthcare FSA?
      If you paid the entire orthodontia bill of $3,000 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 2011 and the orthodontist is charging you $3,000. On January 15, 2012, you decided to pay the lump sum amount. Since you paid for the expense during the grace period, you would be reimbursed from the 2011 FSA balance first (if money is still available) and then from the 2012 FSA balance. (Note: the amount you are reimbursed cannot exceed the amount paid to the orthodontist or the total amount of your 2011 and 2012 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 elected to contribute $100 per month or $1,200 for the calendar year into a Healthcare 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 Healthcare FSA will reimburse you the full $300. With a Healthcare FSA, you are eligible to receive reimbursement up to your 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.
    • When filing a claim for my dental expenses, what should I provide?
      Acceptable documentation consists of one (please do not send both) 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 service, amount of service, description of services provided, name of service provider and name of patient.
      *Please note that a cancelled check or credit card receipt alone is not acceptable documentation.

      NOTE:If the documentation you provide indicates "estimated" or "pending" insurance payment, PayFlex will not be able to approve the claim until final documentation is received. The final documentation, which is generally your insurance company's EOB, must show your financial responsibility. If your dentist uses an "estimated" or "pending" amount to determine your expense, instead of the actual amount as determined by your insurance provider, and you pay the “estimated” amount at the time of service, this could result in an overcharge by your dentist if your insurance pays more than anticipated.
    • 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 My HealthHub Resources 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 HealthHub 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.
    • How is a “grace period” different than a “run out period”?
      A run out period is the period of time you have to file claims incurred during the plan year and is typically 90 days after your plan year ends. For example, if your plan runs from January 1 through December 31, you would have until March 31 of the next year to file claims incurred between January 1 and December 31. Whereas the grace period extends the timeframe you have to incur eligible expenses. Therefore, if you have a calendar year plan, with a grace period you have the ability to incur expenses up until March 15 of the next 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?
      Once the grace period ends, any remaining balance will be forfeited. The grace period is offered by your employer to help you avoid forfeiting your money by allowing an additional 2½ months to incur eligible expenses.
    • What is a grace period?
      A grace period extends the time that you are allowed to incur eligible healthcare 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. Any amount not used by the end of the grace period will be forfeited.
  • All About Reimbursement Accounts
    • How can I elect Direct Deposit?
      You can elect Direct Deposit online by accessing your account and then selecting “Enroll in Direct Deposit” from the left navigational panel. You will be required to provide your bank account type (checking or savings account), your account number, your routing number and your bank name. You can also download a Direct Deposit form from My Resources on the web portal or request a form from Customer Service.
    • How does automatic reimbursement of insurance premiums work?
      If you have elected to receive automatic reimbursement from your account for insurance premium payments, you do not have to submit claims for these expenses in order to be reimbursed. To verify whether or not you chose automatic reimbursement, please refer to your confirmation letter from Extend Health. If you would like to change your election, call Extend Health at the number listed on the Contact Page of the web portal.
    • How will I be reimbursed for eligible expenses?
      Once your claim(s) and receipt(s) have been received and approved, you will receive your reimbursement within 14 days. If you have elected direct deposit, your reimbursement will be deposited into your checking or savings account within two to three days of the claim approval.
    • What expenses can I submit?
      Your Extend Health Account is a convenient way to be reimbursed for eligible healthcare-related expenses. A complete list of eligible expenses can be found in My Resources under Educational Materials or by phoning Customer Service.
  • Managing My Settings
    • How do I change my email address?
      Login to your HealthHub 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 HealthHub 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 My HealthHub Resources.

    • What is eNotify™ and how do I enroll in it?
      eNotify™ is HealthHub’s electronic notification service that is used to provide updates on your account balance (Balance Reminder), notifies you when your claim has been received (Claim Received) and when it has been processed (Explanation of Benefits), and alerts you when additional documentation is needed for your PayFlex Card® transactions (Receipt Request Letter). You choose which notifications you want to receive as well as when and how you want to receive them.

      To enroll in eNotify™, login to your HealthHub account and select My Settings. Then click on Manage Notifications, enter your email address twice and select the notifications you wish to receive either via email or web alert. To save your changes, click Submit.

    • What is eNotify™ and how do I enroll in it?
      eNotify™ is HealthHub’s electronic notification service that is used to provide updates on your account balance (Balance Reminder), notifies you when your claim has been received (Claim Received) and when it has been processed (Explanation of Benefits). You choose which notifications you want to receive as well as when and how you want to receive them.

      To enroll in eNotify™, login to your HealthHub account and select My Settings. Then click on Manage Notifications, enter your email address twice and select the notifications you wish to receive either via email or web alert. To save your changes, click Submit.

  • 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, an alert message will be posted on www.HealthHub.com under Alerts on My Dashboard.  In addition, if you are enrolled in the email option for eNotify (PayFlex’s electronic notification service), you will receive an Explanation of Benefits for overpayment from eNotify@payflex.com.  If you do not select the email option for Explanation of Benefits notices, PayFlex® will mail the notices to your home address on file.  All documents will be stored online, in case you misplace the notice. 
       

      Access your Explanation of Benefits online    
      To view and/or download notices, go to www.HealthHub.com, click on Employee Account Login and enter your username and password.  On My Dashboard, select My Documents from the left hand navigation bar, then select Coupon with EOB Report from the drop down menu.  If your account is in overpayment, you will see the Explanation of Benefits notice(s) that have been sent to you.  In addition, if your account is in overpayment status, your card will be deactivated.  You can view your card status online by clicking on Manage My Debit Cards under Quick Links on the left hand navigation bar.
       

      Enroll in eNotify
      To enroll in eNotify, login to www.HealthHub.com and select My Settings.  Then click on Manage Notifications, enter your email address twice and select the notifications you wish to receive either via email or web alert.  To save your changes, click Submit.

    • How do I know if my account is in overpayment status?
      If your account is in overpayment status, an alert message will be posted on www.payflex.com/gendyn under Alerts on My Dashboard.  In addition, if you are enrolled in the email option for eNotify (PayFlex’s electronic notification service), you will receive an Explanation of Benefits for overpayment from eNotify@payflex.com.  If you do not select the email option for Explanation of Benefits notices, PayFlex® will mail the notices to your home address on file.  All documents will be stored online, in case you misplace the notice. 
       

      Access your Explanation of Benefits online    
      To view and/or download notices, go to www.payflex.com/gendyn, click on Employee Account Login and enter your username and password.  On My Dashboard, select My Documents from the left hand navigation bar, then select Coupon with EOB Report from the drop down menu.  If your account is in overpayment, you will see the Explanation of Benefits notice(s) that have been sent to you.  In addition, if your account is in overpayment status, your card will be deactivated.  You can view your card status online by clicking on Manage My Debit Cards under Quick Links on the left hand navigation bar.
       

      Enroll in eNotify
      To enroll in eNotify, login to www.payflex.com/gendyn and select My Settings.  Then click on Manage Notifications, enter your email 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 Benefits 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 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 Benefits (EOB) from PayFlex® and an Explanation of Benefits from my dental insurance provider?
      An Explanation of Benefits 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.
  • If Your Employer Offers the PayFlex Card for Commuting Expenses
    • I am using my PayFlex Card® at a transit station but the transaction was denied. Why?
      You should be able to use your PayFlex Card® at transit station kiosks and ticket windows, however, you may not be able to use the card at merchant stands in the transit station that sell newspapers and food items in addition to transit passes. Your PayFlex Card® will only be accepted at credit card machines that only sell transit passes.
    • If I couldn’t use my PayFlex Card® to purchase my transit pass, can I submit a claim to PayFlex® for reimbursement?
      If your employer allows a cash reimbursement option, then you may submit a claim to PayFlex® for reimbursement.
    • May I use my PayFlex Card® for transit expenses?
      If your employer offers the PayFlex Card® for transit expenses and you have elected to participate in the transportation spending account, then you may use your PayFlex Card® to pay for your transit passes/vouchers.
    • What should I do if I try to use my PayFlex Card® and the transaction is denied?
      If you try to use your PayFlex Card® to purchase a transit pass and your transaction is denied, please make sure that you have confirmed your available balance and that you have enough funds for the purchase. In addition, you will want to confirm that the vendor/credit card machine you are attempting to use sells only transit products. You should be able to use your PayFlex Card® at transit station kiosks and ticket windows, however, you may not be able to use the card at merchant stands in the transit station that sell newspapers and food items in addition to transit passes.
    • Where can I use my PayFlex Card® as of January 1, 2011?
      You may use your PayFlex Card® at locations and vendors that sell only transit passes. This would include ticket windows and kiosks at transit stations. The PayFlex Card® will not work at any location that sells other types of products in addition to transit passes, even if you are able to purchase transit passes at that location. This is an IRS restriction.
  • 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 My HealthHub Resources 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.
  • Filing A Claim
    • 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 file a claim online, select File a Claim on the left navigation bar and follow the easy steps. To print a paper claim form, click on My Resources and then select Administrative Forms.
    • 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 HealthHub account and select File a Claim on the left navigation bar or visit My HealthHub Resources 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 healthcare 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 healthcare 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 healthcare 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. Starting January 1, 2011, certain OTC drugs and medicines will require a prescription from your physician in order to get reimbursed.

      Please note that a cancelled check is not acceptable documentation.

    • What type of documentation is acceptable to submit for reimbursement of healthcare 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.

      Please note that a cancelled check is not acceptable documentation.

  • Transit Program (online ordering system)
    • What if my mailing address is outside the incorporated 50 United States?
      Your mailing address must be within the 50 Incorporated United States in order to take advantage of the pre-tax transit pass program. Since the passes are typically time sensitive and sent through a bulk mailing system we are unable to accommodate the additional postage and mailing time required to ship orders to employees with foreign mailing addresses (including those in Puerto Rico and Canada).