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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MasterCard® is a registered trademark of MasterCard International Incorporated.

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

How do I activate my new card?
If you receive a new card with an activation label, call Card Services at 1-877-261-9951.  This is the same number you will see on the card activation label.  Then enter your card number followed by the # sign.  You will then enter the last four digits of your Social Security number (SSN).  If your SSN is not accepted, you may need to enter the last four digits of your Employee ID number.  Once you finish these steps, your card will be activated.  You can then use your card right away.   
 
When can I call to activate my card?
You can call to activate your card as soon as you receive it.  Remember, you only have to activate your card if it has an activation label on it.  To activate your card, call 1-877-261-9951.  This is the same number you will see on the card activation label.  You can call this number at any time. 
 
After I activate my card, when can I start using it to pay for eligible expenses?
You can use your card as soon as you activate it.  Note: You must have funds in your account to use the card.  You can view your account balance online on My Dashboard, under Financial Center – My Accounts.
 
I previously received a card and didn’t have to activate it.  Why do I need to activate my new card?
Before May 1, 2013, all PayFlex Cards were pre-activated.  That means that you didn’t have to activate your card before using it.  We have changed the activation process to place more security on your card and to decrease the fraud risk.  If your card has an activation label, you must call 1-877-261-9951.  You will have to activate the card before you can use it. 
 
If I activate my card and then order a card for my spouse or dependent, do they need to activate their new card?
No.  If your card is already active, your spouse or dependent does not need to activate their new card. This means your spouse or dependent should be able to use their card as soon as they receive it.  Note:  If the card is already active, it will not have an activation label on it.  If someone tries to activate an active card, they’ll hear this message:  “Our records indicate this account has already been activated. Please contact the customer service phone number on the back of your card if you need further assistance.” 
 
I already have a card and did not have to activate it.  If I order a card for my spouse or dependent, do they need to activate their new card?
No.  Your spouse or dependent does not need to activate their new card. Your spouse or dependent should be able to use the card immediately, as long as funds are available in your account.  Note: Activation is not required if the card does not have an activation label on it.
 
If I receive a replacement card, do I need to activate it?
Yes.  If you receive a new card with an activation label, you must activate the card before you can use it.  To activate the card, call 1-877-261-9951.  This is the same number you will see on the card activation label.  You’ll get a replacement card when your current card expires or if you report your card as lost or stolen.
 
If I’m unsuccessful in activating my card, how many attempts can I make in a day? 
You should not have a problem activating your card.  However, you can make two attempts to activate your card each day.  If you’re unable to activate your card after the second try, you must wait until the next day to try again. 
 
What should I do if I have trouble activating my card or if I have more questions?
Please call Member Services.  The number is on the back of your PayFlex Card. 

How do I get a PIN for my PayFlex Card®?
Call Card Services at 1-888-999-0121. You will be asked to enter your card number, the three-digit security code (located on the back of your card) and your five-digit zip code.  Then you must enter a new four-digit PIN.  This means you need to create your own PIN.  To do this, enter four digits of your choice.  To confirm your PIN, re-enter your four digits.  Once you create your PIN, you can use it right away. 

Note: Please make sure to remember your PIN, as you will not receive a confirmation of your PIN. 

When will I have to use a PIN for my card transactions?
Starting April 1, 2013, you can use your card as “debit” or “credit".  Some merchants may now ask you to use your card as “debit”.  This means you will need a PIN to complete the transaction.  Please note that you are not required to select “debit”; you can still use your card as “credit.”

Why do I need a PIN now? 
Some merchants may now ask you to use your card as “debit”.  When you use your card as “debit,” you need a PIN to complete the transaction.  Also, having a PIN decreases the risk of fraudulent use of your card if it is lost or stolen.  Please note that you are not required to select “debit”; you can still use your card as “credit.”

How do I know when a PIN is required? 
When you swipe your card, you will be prompted if a PIN is required.  Please note that if you do not yet have a PIN, you can still use your card as “credit.” 

When using the card, should I select “debit” or “credit”?
If the merchant allows you to select “debit” or “credit”; either option will work.  This means you may choose “credit” and sign the receipt.  If you select “debit,” you will have to enter your PIN.  

What if I forget my PIN?
You can call 1-888-999-0121 to create a new PIN at any time.

Will my spouse or dependents need a different PIN for their debit card?
No.  There is one PIN per cardholder account.  Please make sure that any family member that has a separate debit card knows your PIN.

What happens if I order a new card for one of my dependents and he or she calls to create a PIN?
If your dependent calls to create a PIN, this new PIN will be the PIN for all cards on your account.If you had already set up a PIN, that PIN will not work anymore.When anyone creates a new PIN, it will override the PIN previously created.

What happens if I do not have a PIN and the merchant requires that I use one?
If you are asked to use a PIN, you can create one by calling Card Services.  The toll-free number is 1-888-999-0121.  If you do not yet have a PIN, you can still use your card as “credit.”  If you are unable to use your card as “credit,” you can pay for the eligible expense with cash, check or personal credit card.  Then submit a claim for reimbursement.  

Now that my card will have a PIN, can I withdraw funds at an ATM?
No.  The card will not work at an ATM.

Now that my card will have a PIN, can I get cash back when using the card at a merchant?
No.  You can only use the card to pay for eligible expenses.

Certain OTC items 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 Resource Center and click on Planning Tools.

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.

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®.

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®.  To access the Consumer Center, simply login to the HealthHub website and select Shop Online on the left-hand navigation bar. Keep in mind, 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 Resource Center and click on Planning Tools.

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.

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.

Login to your PayFlex 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.

As you incur eligible health care expenses, you can use your PayFlex Card® as a form of payment. You can use your card as "credit" or "debit."  When you choose "debit", you will need to enter a Personal Identification Number (PIN). To create a PIN, please call 1-888-999-0121.

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 detailed receipts and Explanation of Benefits (EOB) in the event that you need to provide them to the IRS.

If you purchase eligible health care 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.

No, you do not need to use your card for all health care expenses. To use funds in your FSA, you can always use another form of payment for your expenses and submit a claim for reimbursement.

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, you can continue to use your PayFlex Card for your eligible expenses during your employer's grace period.

There are four key benefits:

• Immediate payment of your expenses from your savings or reimbursement account
• Increased personal cash flow
• Reduced paper claim filing
• Ease of use of your pre-tax funds

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. Or pay the entire bill with another form of payment and submit a claim for reimbursement for the remaining balance in your account.

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 PayFlex 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.

The PayFlex Card® is your account debit card. You can use it to pay for your eligible health care expenses. It is accepted at 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.

An inventory information approval system (IIAS) is a system that identifies whether a product or service purchased with a health care card is an eligible or ineligible health care expense according to IRS 213(d). An IIAS is required at merchants such as drug stores, pharmacies, grocery stores, hospitals, etc. in order for health care cards to be accepted.

If your card is denied because the merchant does not have an inventory information approval system, you have two options:

1) Use another form of payment to purchase your health care item and submit a claim for reimbursement.

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

Contact us as soon as possible to report a lost or stolen card to help limit any potential loss or liability as outlined in your cardholder agreement. We can then cancel your card and send you a new one. If you’re still worried about identity theft after cancelling your card, you can use MasterCard’s Identity Theft Resolution Services at no cost. They can assist you with the process of restoring your identity. Identity Theft Resolution Services include:

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

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

MasterCard® is a registered trademark of MasterCard International Incorporated.

If your drug store or pharmacy has not implemented an IIAS, you can continue to purchase eligible health care expenses from that location with another form of payment and submit a claim for reimbursement.

If your provider does not accept MasterCard®, you will be required to use another form of payment and submit a claim for reimbursement.

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.

 

*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.

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®.

The PayFlex Card® 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 health care dollars for ineligible expenses.

Please note, 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.

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 PayFlex account and click on Learn More next to the claim substantiation alert message.

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.

A statement including your PayFlex Card® transactions is only available online. Login to your PayFlex account and select Financial Center on the top navigation bar. Then select an account from the drop down menu to view your recent transactions.

Although allowed as a medical deduction for individual taxpayers on their personal income tax returns, insurance premiums are not an eligible expense under IRS Section 125 Health Care Flexible Spending Accounts (FSAs).

The IRS recognizes that orthodontia is different from any other type of health care. For reimbursement of orthodontia, what you will need to submit depends on what is allowable under your plan and the payment option that you choose. Please remember to submit to your dental insurance carrier prior to submitting to PayFlex.

• Coupon Payment Option – If your plan allows, this option works best when the orthodontist provided you either a coupon book or a monthly reminder statement of expenses. You must submit the coupon or itemized statement with a completed claim form. You will do this as the service is provided.


• Monthly Payment Option (Auto Pay) – If your plan allows, the Auto Pay option allows you to set up recurring monthly reimbursements. To do this, you must submit a copy of the contract or agreement* that you have with the orthodontist along with the completed claim form and the box on the claim form checked indicating you wish to establish automatic monthly reimbursements. The claim form is available in My HealthHub Resources. Once we process the first claim, we will automatically reimburse you each month. You do not have to submit a claim form for each visit. We use the agreement to set the monthly amount that you will receive from the FSA for the length of the agreement. Note: You must be enrolled in the FSA and have funds available. You will receive the monthly payments on or about the due date stated in your agreement.
  
  *You can obtain a contract/payment agreement from the orthodontist. That agreement must include the following information:
  • Patient name
  • Date the service began
  • Length of service
  • Cost of the initial banding work
  • Dollar amount you must pay each month
  
  Note: If you use the Auto Pay option, you cannot also use the PayFlex Card® for these expenses.


• Total Payment Option – Based on your plan, you may have the option to pay the full amount when the treatment begins. If your plan allows and you didpay the full amount, you can receive reimbursement for the amount you paid out-of-pocket. We will reimburse you up to your FSA election amount, minus any previous FSA payments. Note: If you have sent in other claims, make sure to check your FSA balance. You can do this online. This will let you know how much you have available to cover your orthodontia treatment.
  
  With this option, you must include a copy of your paid receipt. You also need to include an itemized statement. This must includethe following information:
  • Provider name
  • Patient name
  • Date the service began
  • Amount you paid
  • Amount insurance will pay
  Note: You can only submit this once for reimbursement.

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

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

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

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


Orthodontia Example: Orthodontia treatments provided over two plan years
When treatment is spread over two plan years and you do not pay for the full expense up front, you have two options:

1. You can pay the monthly payment amount based on the orthodontia agreement by submitting a claim each month with your payment coupon.
2. You can set up an automatic payment (Auto Pay) with PayFlex® based on the amount set by the orthodontia agreement. To set up Auto Pay, you will need to complete a claim form with the monthly payment amount listed under the Amount Requested column and Ortho – Auto Pay under the Type of Service column. When completing the form, make sure to check the box for Automatic Monthly Reimbursement for Orthodontia expenses. In addition, a copy of the ortho contract/agreement must be sent in with the claim form. Once PayFlex® processes this claim, you will be reimbursed on a monthly basis near the due date stated on your orthodontia contract agreement.

I am currently set up with PayFlex’s monthly payment option (Auto Pay) for my orthodontia treatment. If I choose not to enroll in an FSA for the following plan year, will the Auto Pay process continue during my grace period (e.g., January 1 – March 15)?
If you choose not to enroll in an FSA for the following plan year and you have money left in your FSA, the Auto Pay process will automatically continue for the first 2 months of the grace period. The grace period, if offered by your employer, generally covers expenses incurred between January 1 and March 15. With Auto Pay, the orthodontia payments are scheduled based on an amount for an entire month. Therefore, in this situation, the Auto Pay for your January and February payments will be processed. However, the Auto Pay for your March payment will be denied, since coverage ends on March 15 and does not continue for the entire month of March.

In this example, your Health Care FSA will reimburse you the full $300. With a Health Care FSA, you are eligible to receive reimbursement up to your annual election amount beginning the first day of your plan year. In other words, you can use your entire election beginning on day 1 of the plan year regardless of whether you have contributed your full election amount on that date.

In some cases, you will be asked to provide a "Letter of Medical Necessity" from your physician to substantiate your claim. For example, treatments such as massage therapy or weight loss programs that can be for both medical and non-medical reasons may be subject to this requirement. Visit Resource Center to download a Letter of Medical Necessity form located in Administrative Forms.

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

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.

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.

Managing your FSA is as easy as 1-2-3:

1. Estimate the amount you will spend on out-of-pocket health care expenses and/or dependent care expenses during the plan year.
2. Decide how much you wish to set aside into your Health Care FSA and/or your Dependent Care FSA. The amount(s) you wish to set aside will be deducted from your paycheck (on a pre-tax basis) in equal amounts each pay period.
3. As you incur eligible health care and/or dependent care expenses throughout the year, you can access your funds by using your PayFlex Card® (if offered by your employer) or get reimbursed by submitting a claim.

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.

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.

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.

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.”

Yes, the IRS maximum is currently $5,000 per household per plan year.

Yes, the Health Care Flexible Spending Account (FSA) annual maximum contribution amount is $2,600. This limit is on a per-participant basis.  This means, if both you and your spouse are eligible to participate in an employer-sponsored Health Care FSA, you may each contribute up to the individual limit of $2,600 if your spouse’s employer’s plan also offers the IRS maximum of $2,600. Your plan may have a lower limit, so you should check with your Human Resources/Benefits Department or your employer’s plan description to confirm the contribution amount allowed for a Health Care FSA.

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.

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

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.

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.
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.

A Flexible Spending Account (FSA) provides a tax-advantaged way to pay for eligible out-of-pocket health care expenses and work-related dependent day care expenses. Authorized by the Internal Revenue Code, Section 125, an FSA allows you to pay for eligible expenses with “pre-tax” dollars, thereby lowering your taxable income.

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

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

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.

After you incur an eligible expense, you can:

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

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

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

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

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

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

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

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

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

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

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

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

Here are some examples:

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

Acceptable documentation consists of one of the following:

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

Please note that a cancelled check is not acceptable documentation.

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

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

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

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?”)

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.

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®.

OPTION 1: (Preferred Method)
Once you receive an Explanation of Benefits (EOB) from your insurance provider, showing your exact patient responsibility, pay for your dental service over the phone by providing the number on your PayFlex Card.

Benefits:

• Expense is automatically deducted from your health care account
• Ensure that you only pay for what you owe
• Helps keep card active
• Eliminates claim filing

Things to consider:

• You may be required to provide the Explanation of Benefits to PayFlex at a later date to confirm your expense was eligible. Please be sure to keep your EOB.
• To confirm an expense is eligible, IRS regulations require verification of the date of service, description of service or product and your patient financial responsibility, which is provided on an EOB.

 
OPTION 2: (Next best method)
Once you have received dental treatment, pay for the bill with cash, check or personal credit card and submit a claim to PayFlex for reimbursement.  (Make sure to send a copy of your EOB or itemized statement with your claim)

Benefits:

• Quick reimbursement
• Helps keep card active
• Prevents overpayment status

Things to consider:

• If the itemized statement from your dentist indicates insurance has been filed, is pending or is estimated, you must wait and submit your claim after you receive your EOB from your insurance provider.

 
OPTION 3: (Only if your dentist requires you to pay before insurance pays)
Once you have received dental treatment, pay for the bill with your PayFlex Card at your dentist office. 

Benefits:

• Expense is automatically deducted from your health care account
• Eliminates claim filing

Things to consider:

• If your dentist charges you for an estimated amount OR an amount that is greater than your final patient responsibility (after insurance pays its portion), your health care account will be placed into overpayment* status and action will be required.  *See FAQ - “What does overpayment status mean?” 
• To resolve your overpayment status, submit payment to PayFlex or submit a claim for a previously unreimbursed eligible expense to repay your FSA.  By taking action, your PayFlex Card will remain active.
• Should you or your dentist receive reimbursement from any other coverage such as insurance, ask your dental provider to credit any amount received back to your PayFlex Card.  If that is not possible, you are responsible for reimbursing the plan for the amount you overpaid.

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®.

An Explanation of Payment from PayFlex® is a document notifying you what claims have been approved for reimbursement, denied, or whether your account is in overpayment status. An Explanation of Benefits from a dental insurance provider is a statement which details what services have been paid by the insurance plan and what is owed to the dentist by the insured individual.

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.

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 your employer allows a cash reimbursement option, then you may submit a claim to PayFlex® for reimbursement.

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.

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.

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.

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

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

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

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

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

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

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

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

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

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

Acceptable documentation consists of one of the following:

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

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

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

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

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

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

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.

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.

If you have any funds left in your account at the end of the year, they will be forfeited. This is the IRS “use-it-or-lose-it” rule. Review all of your expenses incurred during the plan year. Make sure you have filed a claim for each before the run out period ends. Any funds left in your FSA at the end of the run out period are forfeited.

A grace period extends the time that you are allowed to incur eligible health care and/or dependent day care expenses. For a calendar plan year, the timeframe would usually begin January 1 and end on December 31. However with a grace period, you will have an additional 2 ½ months beyond December 31, therefore allowing you to incur expenses up until March 15 of the following year. In other words, you will have a total of 14 ½ months to utilize your 12 month election.

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

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

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

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

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