Participants

Frequently Asked Questions

FSA Medical | FSA Dependent Care | HRA/MRA | HSA | COBRA

FSA

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 participant 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?

An itemized receipt from the provider of service is required and needs to include the following:

  • The provider’s name and address
  • Date of service
  • Patient’s name
  • Description of services provided
  • 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.)
  • 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 what insurance has or is expected to pay.

A receipt showing a balance due or payment made on an 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, OTC medications require a doctor's prescription to be eligible for FSA reimbursement. When a claim is submitted for purchase of an OTC medication, 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.) were affected by this change in the law.

Categories 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 eligible. 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 filled, 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 an FSA 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, 2015, your child has braces put on in full in March 2015 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 2015.  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 2015 plan year we can reimburse $1,666.70 in March 2015.  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 2016.  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 a participant terminates?

Flexible spending account plans have regulations that say the annual election must be made available at the participant's effective date. Participants 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 a participant 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 participant'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 participant, the participant's spouse, or the participant'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 a participant's spouse or dependent (if the residence change affects the participant'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/her 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.flexadministrators.com (Only if your employer has 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.
  • On the Mobile App - iOS / Android

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 contact the office.

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 eligible. Items such as nicotine gum and nicotine patches that do not require a prescription are also eligible.

Dependent Care

  1. Who is eligible for the dependent care spending account?
  2. Does my daycare provider have to be licensed in order to participate in the dependent care FSA?
  3. How much can I contribute to the dependent care spending account?
  4. What types of expenses are eligible under Dependent Care FSA?
  5. What types of expenses are not eligible under the Dependent Care FSA?
  6. In what situation can I change my contribution to the dependent care account during the plan year?
  7. What documentation is needed for dependent care reimbursement?
  8. Which dependents are eligible for the dependent care spending account?

1. Who is eligible for the dependent care spending account?

If you are married, you can use the account if you and your spouse work or, in some situations, if your spouse goes to school. You can also use the account if your spouse is disabled and unable to care for the children. Single participants can also use the account.

2. Does my daycare provider have to be licensed in order to participate in the Dependent Care FSA?

Generally, no. The daycare provider you use must claim the money they receive for providing their service as income.  If you participate in the Dependent Care FSA, the IRS will require you to report the Taxpayer Identification Number or Social Security Number of the provider on your federal tax return.  Flex Administrators also requires this information to be provided on the Mandatory Statement for Daycare that is completed each plan year.

3. How much can I contribute to the Dependent Care FSA?

The Dependent Care FSA allows you to contribute up to a maximum of $5,000 pre-tax for one or more qualifying dependents.  If you do not participate in the Dependent Care FSA, the maximum benefit available through the tax credit when you file your taxes is $3,000 for one dependent and $6,000 for two or more qualifying dependents.  If you have two or more qualifying dependents, you are allowed to use the maximum of $5,000 through a Dependent Care FSA, and then also see if you qualify for a maximum of $1,000 tax credit when you file your taxes (the difference between the $6,000 tax credit and the $5,000 Dependent Care FSA).

Please take a moment to go through the dependent care calculator on our website to see which is more beneficial for your family

4. What types of expenses are eligible under Dependent Care FSA?

  • Care provided inside or outside the participant's home by anyone other than your spouse, a person you list as your dependent for income tax purposes, or one of your children under age 19.
  • If your dependent is in kindergarten or higher grades (through age 12), the cost of schooling must be separated from the cost of care.
  • A dependent care center or child care center (if the center cares for more than six children, it must comply with all applicable state and local regulations).
  • A housekeeper, an au pair, or nanny whose services include, in part, providing for a qualifying dependent.
  • Day care costs while in day camps
  • FICA and FUTA taxes
  • Preschool or nursery schools

5. What types of expenses are not eligible under the Dependent Care FSA?

  • Babysitting for social events
  • Educational expenses for a child in kindergarten or higher
  • Charges for an overnight camp
  • T-shirt charges for camp or daycare facility
  • Transportation expenses
  • Food expenses
  • Expenses that you might take as a child care tax credit on your tax return

6. In what situation can I change my contribution to the dependent care account during the plan year?

  • When the dependent ceases to qualify as a dependent (i.e. the child attains age 13)
  • When the participant switches to a new dependent care provider
  • When the cost of dependent care increases or decreases. However, a mid-year election change due to cost where the dependent care provider is a relative of the participant is not allowed.

7. What documentation is needed for dependent care reimbursement?

A receipt signed by the dependent care provider must accompany all dependent care requests for reimbursements. This receipt must show the dates the daycare was provided, the name of the child who received the care, the name of the person making the payments, and the payment amount.

You can make up your own receipts leaving the dates and amounts blank for your daycare provider to complete. (The receipts don’t have to be formal-see example below.)

Receipt for Child Care Services
click this image to download a full-page of receipts

The dependent care account can only reimburse with funds deposited into the account (deductions withheld from your paycheck).  If there are not funds available when you submit a claim, we will enter it into our system.  As soon as additional funds are deposited, a check will be issued.  If the amount of your expense was more than your account balance, the excess part of your claim will be carried over to the next pay period, to be paid out, as your account balance becomes adequate.

8. Which dependents are eligible for the dependent care spending account?

  1. An individual who qualifies as a dependent for income tax purposes and;
  2. Under the age of 13, or physically or mentally unable to care for himself/herself or;
  3. Your spouse or other dependent (parent) who is physically or mentally unable to care for himself/herself. This person must spend at least 8 hours a day in your home.

HRA/MRA

You may download these FAQs in PDF format via this link.

  1. What is an HRA?
  2. What types of expenses will an HRA reimburse?
  3. Who is covered by an HRA?
  4. Is there a cost to me?
  5. If I have an HRA & an FSA, which pays first?
  6. How can I get reimbursed for these types of expenses?
  7. How much time do I have to submit a claim after the plan year has ended?
  8. Do I have to pay the provider before requesting reimbursement?
  9. What is an EOB?
  10. How do I check my available balance?

1. What is an HRA?

A Health Reimbursement Arrangement (HRA) is a participant benefit plan designed to help offset expenses incurred by the participant (and dependents). When you participate in an HRA, your employer provides the funds to reimburse you for eligible expenses.

2. What types of expenses will an HRA reimburse?

Your employer will determine the expenses that are eligible for reimbursement. Typically, employers allow for reimbursement of a portion of medical deductibles and/or co-insurance. Some HRAs are designed to reimburse dental, vision, or prescription expenses.

3. Who is covered by an HRA?

Typically, your spouse and dependents will be covered by an HRA. In some cases, your employer can limit reimbursement to expenses incurred only by you.

4. Is there a cost to me?

An HRA is completely funded by your employer. All participants are required to receive a Summary Plan Description (SPD) describing the HRA. The SPD will identify your rights and responsibilities as a participant.

5. If I have an HRA & an FSA, which pays first?

Usually, if both HRA and Flexible Spending Account (FSA) plans are provided, the funds in an HRA must be exhausted before reimbursement may be made from the FSA. However, the HRA Plan Document can specify that expenses cannot be reimbursed under the HRA until the FSA funds are exhausted. Please refer to your Summary Plan Description to determine which plan must be used first.

6. How can I get reimbursed for these types of expenses?

Please refer to the "how to file a claim page" for a detailed explanation on how to receive reimbursement for eligible expenses.

7. How much time do I have to submit a claim after the plan year has ended?

Your employer will determine the length of time participants are permitted to submit claims for reimbursement after the plan year has ended. This information can be found in your Summary Plan Description.

8. Do I have to pay the provider before requesting reimbursement?

In most cases, you do not have to pay the provider before you are reimbursed. However, some providers may require payment when the expense is incurred.

9. What is an EOB?

All insurance carriers are required to provide the participant with an Explanation of Benefits (EOB) after services are performed. Examples can be found here. The EOB usually includes the following information: name of the provider, date of service, description of the service, provider’s charge amounts and how they are applied toward the deductibles, co-insurance, copays, and amounts not allowed by your insurance company.

10. How do I check my available balance?

Flex Administrators offers two different ways for a participant to obtain information about his/her HRA:

  1. You can call Flex Administrators, Inc. at (616) 456-7908 or toll free at 1 (800) 968-3539, or
  2. You can access our website at: www.flexadministrators.com

When you enroll in the plan, you will be mailed a letter containing the details of how to obtain information from this site.

HSA

Please visit this External Link

COBRA

  1. How do I access my COBRA Account?
  2. How long before my COBRA coverage is active from the time I submit my first payment?
  3. Can I pay my premium online?
  4. I lost my coupon book, how do I get a new one?
  5. I elected COBRA, but I got a notice saying that my insurance did not cover one of my expenses. What should I do?
  6. My COBRA payment is late, will it be accepted?
  7. Will I be mailed a new insurance card?

1. How do I access my COBRA Account?

Please contact us and we will send you log in information. If you have previously set up a log in ID and password but have just forgotten it, please click this link "FORGOT YOUR LOGIN ID OR PASSWORD" and follow the prompts.

2. How long before my COBRA coverage is active from the time I submit my first payment?

Once we receive your election and payment, it typically takes 7-10 business days for the carrier to have your coverage reinstated.

3. Can I pay my premium online?

Yes, please log in to your account, choose the COBRA/RETIREE tab towards the top of the screen, and then choose PAY PREMIUM. You can pay your premium via checking account draft or credit/debit card.

4. I lost my coupon book, how do I get a new one?

Please call our office and we can send you a new set of coupons. You can also log in to your account line to see your current amount due.

5. I elected COBRA, but I got a notice saying that my insurance did not cover one of my expenses. What should I do?

It takes about 7-10 business days for insurance companies to reinstate coverage through COBRA. After 2 weeks you can contact your service provider and ask them to rebill your insurance company. If the expense is still not covered, please contact your insurance company directly.

6. My COBRA payment is late, will it be accepted?

Your Initial Premium Payment must be made within 45 days after you elect to continue coverage. Subsequent Premium Payments are due on the first of each month. There is a 30 day "grace period". Premiums must be paid in full by the end of the grace period to avoid retroactive cancellation of your coverage. Your premium is considered paid on the postmark date or on the day you make an online payment. If your payment is late, we will send you a letter explaining why it was not accepted. If you believe the termination is in error, you have the right to request a review. Requesting a review will be explained in your letter.

7. Will I be mailed a new insurance card?

You will only receive a new card if your plan changed. Otherwise, please continue to use the insurance cards you had prior to your Qualifying Event. If you lost your card, please contact your insurance company for a new card.