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Frequently Asked Questions

MEDICAL

  1. What documentation is necessary for medical reimbursement?
  2. Are over-the-counter drugs eligible?
  3. What is the proper documentation necessary to submit for orthodontia expenses?
  4. How is orthodontia reimbursed under a Medical FSA plan?
  5. Is adult orthodontia eligible for reimbursement?
  6. Is teeth whitening and bleaching reimbursable under a health care spending account?
  7. Are weight loss programs eligible under a Medical FSA account?
  8. What happens when an employee terminates?
  9. Can a participant change an election at anytime during the plan year?
  10. What happens to any medical FSA or dependent care FSA money that is not reimbursed at the end of the plan year grace period?
  11. How long from the time Flex Administrators receives my request for reimbursement will I receive a check?
  12. How can I access my flexible spending account information?
  13. Why would a claim be denied?
  14. Are travel expenses eligible through a Medical FSA account?
  15. What types of optical expenses are not eligible through a Medical FSA account?
  16. Are smoking cessation programs and stop smoking items reimbursable under a health care spending account?


1. What documentation is necessary for medical reimbursement?

Itemized receipt from the provider of service is required that includes the provider’s name and address, date of service, patient’s name, description of services provided, and the amount of the charge. For vision claims we require the itemized receipt to show a breakdown of the individual services/items (exam, lenses, frames, etc.) and verification that the glasses have prescription lenses.  Warranty charges are not eligible for reimbursement.  If insurance has paid or is expected to pay any portion of the expense, the cost covered by insurance and the remaining patient balance must be listed.  We cannot reimburse until we know that insurance has or is expected to pay.

A receipt showing a balance due or payment made on account is not considered proper documentation.  Please keep in mind that we do not need to see when a payment was made; we need to see when the service was performed and the expense that was actually incurred.

Claim Documentation Requirements For Health Care Flexible Spending Account (FSA)

2. Are over-the-counter drugs eligible?

In accordance with the Tax Credit Reconciliation Act of 2010 and PPACA Health Care Act, starting January 1, 2011, OTC medications will require a doctor's prescription to be eligible for FSA reimbursement. When a claim is submitted for purchase of an OTC medication after 12/31/10, a prescription receipt must be included with the claim in order to receive reimbursement.

Non-medicated OTC products (gauze pads, diabetes test strips, saline solution, etc.) are not affected by this change in the law. You can continue to receive FSA reimbursement for such items after 12/31/10 in the same manner you do now.

Categories now Requiring a Prescription:

  • Acid Controllers
  • Allergy & Sinus medicine
  • Antibiotics
  • Anti-Diarrheals
  • Anti-Gas Products
  • Anti-Itch & Insect Bite
  • Anti-Parasitic Treatments
  • Baby Rash Ointments/Creams
  • Cold Sore Remedies
  • Cough, Cold & Flu
  • Digestive Aids
  • Feminine Anti-Fungal/Anti-Itch
  • Hemorrhoidal Preps
  • Laxatives
  • Motion Sickness
  • Pain Relievers
  • Respiratory Treatments
  • Sleep Aids & Sedatives
  • Stomach Remedies

Note: Controlled Drugs and Medicines that require a prescription as defined by state law remain eligible for purchase.

However, non-prescription dietary supplements (such as Ensure) and vitamins which are purchased to maintain good health are not. Dietary supplements and vitamins would only be eligible if a letter of medical necessity from a doctor diagnosing someone with a specific medical condition was provided.

Cash register receipts for over-the-counter and prescription expenses will be accepted.  Please make sure the name of the provider, date of service, description of expense and cost are visible on the receipt.  You may also submit the prescription tab/sticker, which shows the name of the patient, date the prescription was filed, name of the medication and the cost of the prescription instead of the cash register receipt.

3. What is the proper documentation necessary to submit for orthodontia expenses?

All first time orthodontia requests must include the Truth in Lending statement or treatment contract from the orthodontist showing the provider of service, patient name, total cost of service, cost covered by insurance, down payment (if applicable), length of treatment, monthly payment amount and begin date/end date of monthly payments.

4. How is orthodontia reimbursed under a medical plan?

Orthodontia is an ongoing expense (which often spans more than one plan year). Because of this, it cannot be reimbursed up front.  The expense is considered to be “incurred” on the date of the monthly treatments.  The amount of the monthly payment can be reimbursed only on a month-to-month basis as treatment happens.  We cannot reimburse for monthly payments in advance.

Please note: we can only reimburse based on the payment plan specified on this contract.  Also, you may submit a request for reimbursement on a monthly basis showing that the monthly payment was made in order to receive reimbursement.

Lump sum payments: If you pay for the entire orthodontic treatment up front we will reimburse on a prorated basis if treatment goes into another plan year.  You must still submit the Truth in Lending statement and documentation showing that the treatment was paid for in full.  For example: Your plan year starts in January 1, 2008, your child has braces put on in full in March 2008 and treatment is expected to last for 18 months.  The total cost for the treatment is $3,000, which you pay for in full in March 2008.  We will take the $3,000 and divide it by the 18 months of treatment for a monthly fee of $166.67.  Since you will have 10 months of treatment in the 2008 plan year we can reimburse $1,666.70 in March 2008.  In order to receive the remaining balance of $1,333.30 you must participate in the plan the following year and request the additional reimbursement in January 2009.  We will keep your documentation on file and you will only need to submit a Request for Reimbursement form.

5. Is adult orthodontial eligible for reimbursement?

For adult orthodontia, a letter of medical necessity is needed stating why the orthodontic treatment is necessary.  Any adult orthodontia for cosmetic purposes is not eligible for reimbursement.

6. Is teeth whitening and bleaching reimbursable under a health care spending account?

Generally, no. Unless there is a medical reason for the discoloration. To be reimbursed for this expense a letter of medical necessity would need to be provided.

7. Are weight loss programs eligible under a Medical FSA account?

Weight loss programs are only reimbursable with a letter of medical necessity from a doctor diagnosing the individual with a medical condition (ie. obesity). A letter of medical necessity will need to be submitted to Flex Administrators each year to ensure the medical condition still exists.

8. What happens when an employee terminates?

Flexible spending account plans have regulations that say the annual election must be made available at the participant's effective date. Employees who terminate their employment before the end of the plan year:

  • May forfeit their account balances, by failing to request reimbursement in the grace period established by the employer. If the participant has a positive health care FSA balance, they may elect COBRA continuation coverage, paying 102 percent of the premium and extending the coverage period until COBRA eligibility expires.

It is possible for an employee to terminate and be reimbursed more than what was contributed to the plan. This is the risk that the employer takes in having a flexible spending account plan.

9. Can a participant change an election at anytime during the plan year?

Generally no.

A change in your election during the plan year is not allowed unless an IRS "change in status" occurs, and the change is consistent with the status change. The following are some examples of how the IRS defines a change in status:

  • Change in employee's legal marital status-including marriage, divorce, death of a spouse, legal separation, and annulment.
  • Change in number of dependents-including birth, adoption, and death.
  • Change in employment status-Any of the following that change the status of the employee, the employee's spouse, or the employee's dependent would qualify: a termination or commencement of employment; a strike or lockout; a commencement of a return from an unpaid leave of absence.
  • Dependent satisfies (or ceases to satisfy) dependent eligibility requirements-This could be due to attainment of age, gain or loss of student status, marriage or any similar circumstance.
  • Residence Change-a change of place of residence of an employee's spouse or dependent (if the residence change effects the employee's eligibility for coverage).

It is important to remember that the change that is taking place must be consistent with the change in status. For example a participant in a health care spending account has a child. The participant could increase their annual election to cover the additional expenses of the new dependent. However, a decrease to their annual election would not be allowed.

10. What happens to any medical FSA or dependent care FSA money that is not reimbursed at the end of the plan year grace period?

Any money that is not used by the end of the plan year grace period is forfeited back to the Plan.

11. How long from the time Flex Administrators receives my request for reimbursement will I receive a check?

All requests are processed within two business days from the date the request is received by Flex Administrators.

12. How can I access my flexible spending account information?

Flex Administrators offers a number of different ways a participant can obtain information on his/hers flexible spending account. They are as follows:

  • Calling Flex Administrators at (616) 456-7908 or 1 (800) 968-3539.
  • Our automated voice response system is available 24 hours a day, 7 days a week by calling (888) 675-8370.
  • Our website link, www.myrsc.com (Only if your employer as requested to be set up for this feature.)  If your employer has, when you enroll in the plan you will be mailed a letter containing the details of how to sign on to the MYRSC (account information) website link.

13. Why would a claim be denied?

  • Improper provider receipt to document expenses (i.e. balance forward statements).
  • Expense is not eligible (ex. Warranties).
  • Expense was not incurred during the plan year.
  • No signature on Request for Reimbursement Form.
  • Documentation is not legible.
  • The Date of Service is cut-off.
  • Balance due statements, cancelled checks, credit card slips, and charge slips are not eligible.

14. Are travel expenses eligible through a Medical FSA account?

For current mileage rates please refer to the home page under ‘Important Updates’

15. What types of optical expenses are not eligible through a Medical FSA account?

Warranties and clip-ons are not eligible expenses.

16. Are smoking cessation programs and stop smoking items reimbursable under a health care spending account?

The cost of the program, and prescription drugs relating to smoking cessation are now eligible. Items such as nicotine gum and nicotine patches that do not require a prescription are now eligible.

FSA  Section 125
FSA • SECTION 125
Flexible Spending
Accounts
HRA  Section 105
HRA • SECTION 105
Health Reimbursement Arrangements
HSA  Section 105
HSA • SECTION 223
Health Savings Accounts
Section 213
SECTION 213
Reimbursable / Unreimbursable Expenses
Cobra Administration
IMPORTANT UPDATES
ACCOUNT STATUS - MyRSC
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