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Frequently Asked Questions
  • My PayFlex Card®
    • Can I buy over-the-counter (OTC) items with the card?
      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.

    • 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®.  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.
    • 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 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.
    • How do I report a lost or stolen card?
      Contact us as soon as possible to report a lost or stolen card to limit any potential loss or liability as outlined in your cardholder agreement.
    • How does my PayFlex Card® work?

      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.

    • I just received my PayFlex Card® in the mail. 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. To use funds in your FSA, 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, you can continue to use your PayFlex Card for your eligible expenses during your employer's grace period.

    • What are the benefits of using a PayFlex Card®?
      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
    • What happens if I have a $1,000 balance in my FSA and I use my PayFlex Card® to pay for a $1,500 health care 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. Or pay the entire bill with another form of payment and submit a claim for reimbursement for the remaining balance in your account.
    • 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 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.
    • What is a PayFlex Card®?
      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.
    • 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 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 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:

      1) Use another form of payment to purchase your healthcare 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
    • 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 health care 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. 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® 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.
    • 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 PayFlex 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 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.
  • All About FSAs
    • Can I change my election during the plan year?
      Due to IRS regulations, your election decision remains in effect for the plan year, unless you have a Qualifying Life Event or status change, such as a marriage, birth or death of a dependent, for example. The process for changing your election due to a status change is ultimately determined by your employer; please contact your Human Resources/Benefits Department to verify this process.
    • Do I have to enroll in my employer’s medical or dental plan in order to participate in an FSA?
      No, enrollment in other group plan(s) is not required in order to participate in an FSA.
    • How do I apply for a change in my election?
      Internal Revenue Service (IRS) guidelines allow you to change your plan contribution during the plan year only for the following qualifying events:
      • Change in legal marital status (marriage, divorce, legal separation, annulment or death of a spouse)
      • Change in number of tax dependents (birth, adoption or death)
      • Change in employment status that affects eligibility
      • Dependent satisfying or ceasing to satisfy coverage requirements (reaching limiting age, gain/loss of student status, marriage)
      • Change in residence that affects eligibility

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

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

      A Flexible Spending Account (FSA) provides a tax-advantaged way to pay for eligible out-of-pocket 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.  The UT FLEX program offers you the option of electing a medical expense reimbursement account, a dependent day care reimbursement account, or both.

      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.
  • Healthcare FSA Claim Tips
    • Can I pay my spouse's health insurance premiums through my Health Care FSA?
      Although allowed as a medical deduction for individual taxpayers on their personal income tax returns, insurance premiums are not an eligible expense under IRS Section 125 Health Care Flexible Spending Accounts (FSAs).
    • How 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.
    • I elected to contribute $100 per month or $1,200 for the calendar year into a Health Care FSA. If I have $100 in my account in January, but incur a $300 expense, how much can I be reimbursed?
      In this example, your Health Care FSA will reimburse you the full $300. With a Health Care FSA, you are eligible to receive reimbursement up to your annual election amount beginning the first day of your plan year. In other words, you can use your entire election beginning on day 1 of the plan year regardless of whether you have contributed your full election amount on that date.
    • Will I need to submit any additional information to substantiate an expense being claimed for a medically necessary treatment?
      In some cases, you will be asked to provide a "Letter of Medical Necessity" from your physician to substantiate your claim. For example, treatments such as massage therapy or weight loss programs that can be for both medical and non-medical reasons may be subject to this requirement. Visit Resource Center to download a Letter of Medical Necessity form located in Administrative Forms.
  • A Grace Period
    • Do I automatically have this option in my plan?
      It depends if your employer chose this optional feature. Please check with your Human Resources/Benefits Department or your employer’s plan description.
    • How does having the grace period affect my enrollment for the new plan year?
      With the grace period, you can incur expenses for an additional 2 ½ months into the next plan year to use up your prior plan year’s balance. So, when planning for the next plan year, you need to take into account any money that you still have left in your account that will be used for expenses during that extra 2 ½ month period so that you set your next year’s contribution accordingly.
    • How does 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 September 1 through August 31, you would have until November 30 to file claims incurred between September 1 and August 31. Whereas the grace period extends the timeframe you have to incur eligible expenses.
    • 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 expenses. For the UT System plan year, the timeframe would begin September 1 and end on August 31. However with a grace period, you will have an additional 2 ½ months beyond August 31, therefore allowing you to incur expenses up until November 15. 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.
  • Managing My Settings
    • How do I change my email address?
      Login to your PayFlex account and select My Settings on the left navigation bar to get started. Please note, the email address you provide will be used for all account communications.
    • How do I enroll in direct deposit?
      • Login to your PayFlex account and select Financial Center on the top navigation bar.
      • Click on Enroll in Direct Deposit on the left navigation bar and complete all required fields.

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

    • How do I sign up for account notifications?
      Login to your PayFlex account and select My Settings. Then click on the notifications link, enter your e-mail address twice and select the notifications you wish to receive either via e-mail or web alert. To save your changes, click Submit.
  • 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 Payment for overpayment from eNotify@payflex.com.  If you do not select the email option for Explanation of Payment 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 Payment 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 EOP Report from the drop down menu.  If your account is in overpayment, you will see the Explanation of Payment 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.

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

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

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

      Benefits:
      • Expense is automatically deducted from your health care account
      • Eliminates claim filing
      Things to consider:
      • If your dentist charges you for an estimated amount OR an amount that is greater than your final patient responsibility (after insurance pays its portion), your health care account will be placed into overpayment* status and action will be required.  *See FAQ - “What does overpayment status mean?” 
      • To resolve your overpayment status, submit payment to PayFlex or submit a claim for a previously unreimbursed eligible expense to repay your FSA.  By taking action, your PayFlex Card will remain active.
      • Should you or your dentist receive reimbursement from any other coverage such as insurance, ask your dental provider to credit any amount received back to your PayFlex Card.  If that is not possible, you are responsible for reimbursing the plan for the amount you overpaid.
    • What does overpayment status mean?
      Overpayment status occurs when you have used the PayFlex Card® to pay for a dental expense and the documentation does not support the amount paid.  For example, if you use your PayFlex Card® to pay for a dental bill that exceeds your final patient responsibility, your account will go into overpayment status OR if you submit an itemized statement from the dentist and it indicates insurance is estimated, pending or filed, the card transaction will be denied until final patient financial responsibility is determined.  Please note, when your account is placed in overpayment status, your PayFlex Card® will be temporarily deactivated until appropriate documentation or payment is provided to PayFlex®.
    • What is the difference between an Explanation of Payment (EOP) from PayFlex® and an Explanation of Benefits from my dental insurance provider?
      An Explanation of Payment from PayFlex® is a document notifying you what claims have been approved for reimbursement, denied, or whether your account is in overpayment status. An Explanation of Benefits from a dental insurance provider is a statement which details what services have been paid by the insurance plan and what is owed to the dentist by the insured individual.
    • What should I do if my account is in overpayment status?
      To keep your account in compliance, you must do one of the following:
      1. Fax, mail or upload a legible copy of the Explanation of Benefits from your insurance provider for the denied expense that indicates the date of service, description of service and final patient financial responsibility to confirm whether the amount equals or exceeds the transaction amount; OR
      2. Fax, mail or upload a detailed receipt or Explanation of Benefits for another eligible expense incurred in the same plan year and having an amount greater than or equal to the original denied expense; OR
      3. Mail a check to PayFlex® for the amount of the original denied expense to repay the plan.
  • Dependent Day Care FSA Claim Tips
    • I just had a new baby and will be home for six weeks. I'm taking my 3-year-old to day care during this time. Will these day care expenses be eligible?
      IRS regulations state that the dependent day care expenses incurred must be due to work-related purposes; therefore, these dependent day care expenses are technically not reimbursable.
    • I pay my neighbor to watch my 13-year-old after school. Is this after-school care considered an eligible expense?
      This would not be considered an eligible expense because the individual being cared for must meet the “qualifying person test” as described by the IRS. A qualifying person includes your dependent who is under age 13 and regularly spends at least eight hours each day in your home.
    • I signed up to contribute $400 per month into my Dependent Day Care Flexible Spending Account (FSA) but my actual expenses are closer to $500 per month. Should I submit my claim form for $400 or for $500?
      You can file your claim for the actual amount of charges, in this case $500. However, you will only be paid up to the amount of money available in your account, not to exceed $400. The remaining $100 would be pending until additional funds are deposited into your account.
    • My 16-year-old daughter cares for my 8-year-old son after school. Can I pay my daughter and file those expenses through my Dependent Day Care FSA?
      No. You can only count work-related payments you make to relatives if they are not your dependents. You cannot claim amounts you pay to:
      • A dependent for which you or your spouse, if married, can claim an exemption.
      • Your child who is under age 19 at the end of the year, even if he or she is not your dependent. (See IRS Publication 503).
    • My child just started kindergarten for which I pay tuition. Is this an eligible dependent day care expense?
      The IRS does not consider educational or tuition expenses as eligible expenses, including kindergarten, first grade and higher. However, you can claim expenses for before and/or after-school care provided the care is custodial in nature and not educational.
    • What are the requirements for getting reimbursed for dependent day care expenses?
      • You and your spouse, if married, must be earning an income, seeking employment, or a full-time student in order to receive the pre-tax benefits of a Dependent Day Care FSA. Please note; volunteer work or working for a nominal salary is not an acceptable form of employment.
      • The expenses must be for a qualifying individual. This includes a dependent of yours younger than age 13, a spouse or another dependent who is physically or mentally incapable of self-care and for whom you can claim an exemption.
      • The services must be provided by an eligible provider of child care. This includes a licensed child care facility that complies with applicable state and local laws and any individual who is not your tax dependent or is your child who is 19 or older.
      • The expense must be for services already received and not services to be provided in the future.

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

      • The annual expense reimbursement may not exceed the lesser of:
        • Your earned income;
        • If married, your spouse’s earned income; or,
        • $5,000 ($2,500 if married, filing separate income tax return).
      • You must file Form 2441 annually with your individual tax return identifying all dependent care providers
    • What expenses are considered eligible expenses under a Dependent Day Care FSA?
      For a listing of eligible expenses, visit Resource Center and click on Planning Tools. For more information, please refer to IRS Publication 503.
    • What if my dependent day care claim amount is greater than my balance?
      If the amount of the claim is greater than your available balance, you will be reimbursed for the amount that is available in your dependent day care account. However, when the next deposit is posted, you will be reimbursed for the remainder of your original claim, up to the amount of the deposit. This process will automatically continue until the entire claim has been paid or until the election amount has been met, whichever comes first.
    • What type of documentation is acceptable to submit for reimbursement of dependent day care expenses?
      Acceptable documentation consists of one of the following:
      • A completed dependent day care claim form with dates of service, name of dependent, amount requested and day care provider’s name and signature. The claim form can be used as an itemized statement if your day care provider provides this information and signs the form where indicated.
      • A completed dependent day care claim form and an itemized statement from your day care provider. The itemized statement must include the provider’s name, your dependent’s name, as well as the specific dates day care services were provided and the cost of care.
    • When can I submit a claim for my dependent day care expenses?
      Dependent day care claims should only be submitted following the completed dates of service.
  • 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 get started, login to your PayFlex account and select File a Spending Account Claim on the left navigation bar or visit Resource Center to download a claim form from Administrative Forms.
    • What does the term “expense incurred” mean?
      IRS regulations say the expense must be incurred before it can be reimbursed. The IRS specifically defines expense incurred as follows: Expenses are treated as having been incurred when you are provided with the health care or dependent day care that gives rise to the expense, and not when you are formally billed or charged for, or pay for the expense.

      Here are some examples:

      • If your coverage was effective beginning July 1 for the FSA plan, then expenses incurred on or after July 1 can be submitted for reimbursement.
      • If you received health care services in December, but waited to pay for those services in January, this would be considered a December expense because the date of service was in December.
      • If your dentist said you needed a crown in January, and you prepaid for the crown in December, this would be a January expense because the date of service would occur in January.
    • What type of documentation is acceptable to submit for reimbursement of healthcare claims?
      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 require a prescription from your physician in order to get reimbursed.
      Please note that a cancelled check is not acceptable documentation.