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Frequently Asked Questions
  • My PayFlex Card®
    • Activating Your PayFlex Card®

      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. 
    • Personal Identification Number (PIN) for 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 PINThis 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.   
    • 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
    • Health Care Flexible Spending Account (FSA) Carryover FAQs

      These FAQs are general in nature and only apply to you if your employer adopted the carryover. For illustrative purposes, we used the maximum carryover amount of $500 and a plan year that runs from January 1, 2013 to December 31, 2013.  Please refer to your plan documents for more information about how the carryover feature may impact your plan.   



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

      ____________________________________________________________________________________________________________

      General FSA FAQs
    • 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.
    • Is there a maximum that I can contribute to a health care FSA?
      Yes, the health care Flexible Spending Account (FSA) annual maximum contribution amount is $2,500. 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 $2,500 if your spouse’s employer’s plan also offers the IRS maximum of $2,500. Please check with your Human Resources/Benefits Department or your employer’s plan description to confirm the contribution amount allowed for a health care FSA.
    • 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 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    • When will COBRA subsidy-eligible participants be notified?
      Letters notifying participants of the subsidy extension were sent to participants between January 20 and January 29, 2010.
    • Who is eligible for the COBRA subsidy?
      Employees (and their dependents) who have been involuntarily terminated between September 1, 2008 and March 31, 2010 are eligible for the COBRA subsidy.
    • Who is entitled to benefits under COBRA?
      There are three elements to qualifying for COBRA benefits. COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events:
      • Plan Coverage - Group health plans for employers with 20 or more employees are subject to COBRA. Both full and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of an employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full time.
      • Qualified Beneficiaries - A qualified beneficiary generally is an individual covered by a group health plan on the day before a qualifying event. This includes an individual who is either an employee, the employee's spouse, or an employee's dependent child. In addition, any child born to or placed for adoption with a covered employee during the period of COBRA coverage is considered a qualified beneficiary. Agents, independent contractors, and directors who participate in the group health plan may also be qualified beneficiaries.
      • Qualifying Events - Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA.
      Qualifying Events for Employees:
      • Voluntary or involuntary termination of employment for reasons other than gross misconduct
      • Reduction in the number of hours of employment
      Qualifying Events for Spouses:
      • Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct
      • Reduction in the hours worked by the covered employee
      • Covered employee's becoming entitled to Medicare
      • Divorce or legal separation of the covered employee
      • Death of the covered employee
    • Who pays for COBRA coverage?
      As an individual that has experienced a qualifying event (e.g. termination of employment or reduction in hours), it is your responsibility to pay for COBRA coverage even if you do not receive a monthly statement. Beneficiaries may be required to pay for COBRA coverage.
  • HSAs Simplified
    • Can a health plan that does not have a deductible for preventive care still qualify as an HSA-compatible health plan?
      A plan does not fail to be treated as an HSA-compatible health plan merely because it does not have a deductible (or has a small deductible) for preventive care. For this purpose, preventive care includes such items as periodic health evaluations, routine prenatal and well-child care, child and adult immunizations, tobacco cessation programs, obesity weight-loss programs, and certain screening services.
    • Can a health plan that imposes a lifetime limit on benefits still qualify as an HSA-compatible health plan?
      A plan does not fail to be treated as an HSA-compatible health plan merely because it imposes a reasonable lifetime limit on benefits provided under the plan. In this case, amounts paid above a lifetime limit will not be treated as out-of-pocket expenses in determining the annual out-of-pocket maximum.
    • Can I be covered by another health plan and still be eligible to contribute to an HSA?
      You only remain eligible to contribute to an HSA if the additional health plan is a qualified HSA-compatible health plan.
    • Can I have a Flexible Spending Account (FSA) with an HSA?
      If you are enrolled in an HSA, you cannot be enrolled in a traditional FSA. However, you are eligible to enroll in a Limited Purpose Flexible Spending Account (LPFSA) along with an HSA, if offered by your employer. An LPFSA allows you to pay for eligible dental and vision expenses on a pre-tax basis, which enables you to preserve your HSA funds for other purposes, including saving for the future.
    • Can I invest my HSA funds?*
      You first need to have a minimum balance in your HSA.  Once you have more than the required minimum balance in your HSA, you can invest any amount over that minimum balance.  You can find this minimum balance amount in the Financial Center of your online account.  From there, go to the investments page.
       
      If you do invest any of your HSA funds, those funds would be in an “investment” account.  Any funds in an investment account are not FDIC-insured.
       
      Once you open an investment account, a monthly investment fee will be taken out of your HSA cash account.  You can view your account fees in the Financial Center of your online account.  Select your Health Savings Account from the drop down menu.  Click on Fee Schedule on the left side.    

      What are my investment options?

      You'll be able to choose from a variety of mutual funds.  You can view these funds in the Financial Center of your online account.  Select your Health Savings Account from the drop down menu. Click on the investment link on the left side of the screen to get started.
       
      Note: You must have more than required minimum balance in your HSA cash account to invest your funds.  You can invest any amount over this minimum balance.

      *Shares of mutual funds are not insured by the FDIC or any other U.S. Government agency, and are not deposits or obligations of, or guaranteed or endorsed by, BNY Mellon or any bank. Past performance is not a guarantee of future results.  All mutual funds are subject to market risk and, when sold, may be worth more or less than their original cost.  You should consider the fund’s investment objectives and strategies, risks, and expenses before you invest.  This and other information is contained in the fund’s prospectus.  Please use the Investment Information area on this site to access a fund’s prospectus and other fund information.  Please read the fund’s prospectus carefully before you invest.  Carefully weigh the advantages and disadvantages of investing your HSA funds before doing so.  Your ability to replace losses in the investment account may be limited by the annual contribution limits of your HSA. 

      Self-directed investment accounts are the sole responsibility of the account owner.  PayFlex does not offer investment advice.  In selecting and classifying the available mutual funds, neither PayFlex nor BNY Mellon is providing any personalized investment advice in connection with this program.  PayFlex and BNY Mellon are not making a recommendation to individual health savings accountholders ("you") that any of the mutual fund investment options are, or would be a suitable or appropriate investment for you. That decision is yours.

      PayFlex does not provide brokerage or trade processing services; processing services are provided by BNY Mellon. BNY Mellon and its affiliates may receive compensation for providing various services to the funds, including distribution (12b-1) and service fees.  PayFlex and BNY Mellon are separate, unaffiliated companies and are not responsible for one another's services, policies and information.

      Remember, investing in mutual funds will transfer money from your HSA Bank Account to your investments.  You may wish to ensure you retain enough money in your HSA Bank Account to accommodate future medical expenses.
       
      System response and account access times may vary due to a variety of factors, including trading volumes, market conditions, system performance, and other factors.

      __________________________________________________________________________________________________
    • Can I use my PayFlex Card® with my HSA?
      Yes, you can and should use your PayFlex Card® with your HSA. You will receive one PayFlex Card® regardless of the number of accounts that you enroll in. For example, if you enroll in an HSA and a Limited Purpose Flexible Spending Account, you will receive one PayFlex Card®. The PayFlex Card® is a MasterCard® and can be used at qualified merchants. Please remember that you are responsible for all record keeping for money spent from your HSA, so save your receipts.
    • Do I need to keep my receipts?
      You must keep all receipts showing expenditures or distributions from your HSA. There are two key reasons to keep your receipts: 1) if you exceed your deductible, you may need the receipts to send to your insurer, and 2) in case you are audited by the IRS, you need to explain your HSA expenditures.
    • How are distributions from an HSA taxed?
      Distributions from an HSA for the qualified medical expenses for yourself or your spouse or dependents who are covered by the High Deductible Health Plan are generally excludable from income for Federal income tax purposes if such expenses are not covered by insurance. Distributions used for purposes other than a qualified medical expense, will be subject to both income tax and a 20% penalty tax beginning in 2011, unless the person who makes a withdrawal from their HSA is age 65 or older, is disabled or deceased.
    • How can I keep track of my balance?
      Login to your HealthHub account to view your balance in the Accounts Snapshot. For more detailed account information, click on View My Account.
    • How much can I contribute if I change from self-only to family coverage under my HDHP during the year?
      How much you can contribute depends on the coverage that you have when you start and end the year.

      • If you have a self-only HDHP on January 1 and a family HDHP on December 1, the last-month rule applies. With the last-month rule, you can contribute as if you were eligible for the entire year. This means that you can contribute as if you had family coverage under the HDHP all year.


      • So, if you have family coverage under the HDHP on December 1 then you can contribute as if you had family coverage for the entire year.  However, if you do contribute up to the family limit for the full year you will have to maintain family coverage under the HDHP through the end of the following year.   If you do not maintain family coverage under the HDHP throughout the following year the contributions you made for the months you did not have the HDHP in the prior year are no longer tax-free.
      • If you start the year with a family HDHP but have self-only HDHP coverage by December 1, the Proration rule applies. Proration means that the maximum contribution amount allowed will be determined based on the number of months you had family and self-only coverage.  For each month of family coverage you can contribute 1/12 of the annual family contribution limit ($6,550), and for each month you have self-only coverage you can contribute 1/12 of the annual self-only contribution limit ($3,300).


      • Example: From January 1 through July 31, 2014, you have a family coverage under an HDHP. From August 1 through December 31, 2014, you have a self-only HDHP coverage. For January through July, you can contribute $3,820.83. ($6,550/12 = $545.83 x 7 months) For August through December, you can contribute $1,375.00. ($3,300/12 = $275.00 x 5 months) In this example, you can contribute $5,195.83. ($3,820.83 + $1,375.00).
      You may want to speak with your tax advisor. He or she can help you to figure out how much you can contribute.
    • How much can I contribute if I do not have the HDHP for the entire year?
      How much you can contribute depends on when you had the HDHP.

      • If you are covered under an HDHP on December 1, then the Last-month rule applies. This means that if you are covered on December 1 you can contribute to your HSA as if you were covered under the HDHP for the entire year. However, if you make this full-year contribution you must remain covered under the HDHP throughout the all of the next calendar year.  Otherwise, you will be taxed on contributions made for the months you were not covered in the first year and will be subject to an additional 10% tax penalty.


      • Example: You have an HDHP starting on May 1, 2014. You still have the HDHP coverage on December 1, 2014. You contribute the full contribution amount for 2014. However, at some point in 2015 you are no longer covered under a HDHP.  You will have to pay income taxes on the amount for those months in 2014 that you were not actually eligible. In this example that would be for the months of January through April 2014. You would also have to pay a 10% tax penalty on that amount.
      • If you have an HDHP for part of the year but not on December 1, then the Proration rule applies. Proration means that you can contribute just for the months that you are eligible. The amount you can contribute to your HSA is determined by dividing the annual contribution limit (e.g., In 2014; $3,300 for self-only, $6,550 for a family) by 12, and multiplying the result by the number of months you are covered under the HDHP during the year.  Note: Eligibility is based on being covered under the HDHP on the first day of each month.


      • Example: On January 1, 2014, you enroll in a family HDHP, but your coverage under that plan ends on April 30, 2014. The most that you can contribute for the year is $2,183.33 ($6,550/12 = $545.83 x 4 months).
      You may want to speak with your tax advisor. He or she can help you to figure out how much you can contribute.
    • How much can I contribute to my HSA?
      Each year, the IRS sets annual contribution limits for HSAs. For 2014, the limit for an individual enrolled in a self-only plan is $3,300. The contribution limit for a family enrolled in a family HDHP is $6,550. For 2013, the limits are $3,250 (self-only) and $6,450 (family).
       
      You can contribute up to these limits while you (or your family) are enrolled in a high-deductible health plan. You can contribute permitted amounts in a lump sum or on a scheduled contribution basis.You can change your scheduled contribution amount at any time during the year as long as you don’t exceed the annual limit.If you are age 55 or older, you can contribute another $1,000 per year. This is a “catch-up” contribution designed to allow additional savings for retirement health expenses.

      This means that the amount that you can contribute is based on a few things.
      1. You must be enrolled in an HDHP.   Do you have self-only or family coverage? 
      2. Did you have coverage under the HDHP plan for the entire year? If not, the maximum contribution amounts may be limited or pro-rated based on the number of months you are enrolled in the plan.
      3. How old are you? Are you 55 or older?  
      You may want to speak to your tax advisor. He or she can help you understand how much you can contribute to your HSA. See also IRS Publication 969 at www.irs.gov.
    • If I am a retiree and age 65 or older, may I receive tax-free distributions from an HSA to pay my contribution to my employer’s retiree health coverage?
      After you reach age 65, you may receive tax-free distributions from an HSA to pay for your employer’s retiree health insurance coverage. Although the purchase of health insurance is generally not a qualified medical expense that can be paid or reimbursed by an HSA, the Code provides an exception for coverage for health insurance once an account beneficiary reaches age 65. This exception applies to both insured and self-insured plans.
    • If I am a retiree who is enrolled in Medicare, may I receive a tax-free distribution from an HSA to reimburse my Medicare premiums?
      Yes, this type of distribution will be tax-free. When premiums for Medicare are deducted from Social Security benefit payments, an HSA distribution to reimburse an amount equal to the Medicare premium deduction is considered a qualified medical expense.
    • If I change health plans and am no longer covered by an HSA-compatible health plan, can I still use my HSA funds to pay for healthcare expenses?
      Yes, you can continue to use your HSA funds to pay for out-of-pocket healthcare expenses if you decide not to continue coverage in an HSA-compatible health plan. However, you can only contribute to an HSA when you are enrolled in an HSA-compatible health plan.
    • If I currently have an HSA with a different custodian, can I keep that account open and still enroll in a HealthHub HSA?
      Yes, you can maintain multiple HSAs at one time or you can transfer all of your HSA funds into one account. However, you should consider the fees associated with maintaining multiple HSAs
    • Is my HSA FDIC-insured?
      Yes.  When you open an HSA, the funds are in a “cash” account.  This is similar to any other bank account.  Like with other bank accounts, the HSA funds are FDIC-insured.
    • Is the HSA custodian responsible for determining whether HSA distributions are used for medical expenses?
      Your custodian has no responsibility for determining whether distributions from your HSA are used for qualified medical expenses. It is your sole responsibility to determine the tax consequences of any distributions, for maintaining adequate records for tax purposes, and for paying any taxes and penalties arising as a result of any such distribution. You are encouraged to consult with your legal or tax advisor concerning any questions you may have.
    • What are the rules that apply if my HSA is transferred pursuant to a divorce decree?
      The transfer of your HSA to your spouse pursuant to a divorce decree is not considered a taxable transfer. After such transfer, the former spouse will be treated as the account holder of the HSA, but the former spouse must request the HSA custodian to transfer the account to his or her name, must provide the custodian with a certified copy of the divorce decree and property settlement or transfer agreement, and must sign appropriate documents to establish the account in that person’s name.
    • What are the tax consequences of HSA distributions following my death?
      If your spouse is the named beneficiary of your HSA, your HSA becomes the HSA of your spouse upon your death, subject to the custodian’s consent and the completion of applicable documents as required by the custodian. The surviving spouse is not required to include any amount in gross income for tax purposes as a result of your death and he or she is subject to income tax only on those distributions, which are not made for qualified medical expenses. If, at your death, your HSA passes to a named beneficiary other than your surviving spouse, the HSA ceases to be an HSA as of the date of your death, and the beneficiary is required to include the fair market value of the HSA assets as of the date of death in his or her gross income for the taxable year that includes the date of death. The includible amount is reduced by the amount in the HSA used, within one year of your death, to pay your qualified medical expenses incurred prior to death. If there is no named beneficiary of your HSA, the HSA ceases to be an HSA as of the date of your death, and the fair market value of the HSA assets as of the date of death is includible in your gross income for the year of death.
    • What expenses are eligible for tax-free distributions from my HSA?
      Distributions made for “qualified medical expenses” are generally excludable from income. For this purpose, the term “qualified medical expenses” means amounts paid for the medical care, as defined in Section 213(d) of the Code, for yourself, your spouse, or your dependents, but only if the expenses are not covered by insurance. This includes amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease or for the purpose of affecting any structure or function of the body, as well as for transportation primarily for and essential to such care. If you incur healthcare expenses before your HSA is established, those expenses will not be considered qualified medical expenses. In addition, qualified medical expenses do not include insurance premiums other than premiums for long-term care insurance, premiums on a health plan during any period of continuation coverage required by Federal law (e.g., “COBRA” coverage), or premiums for health care coverage while an individual receives unemployment compensation. For more information, please refer to IRS Publication 502.
    • What happens to my HSA upon my death?
      You have the right at any time to designate one or more beneficiaries to whom distribution of your HSA will be made upon your death. You also have the right to revoke a prior beneficiary designation and, if desired, designate different individuals as beneficiaries. You should understand that in certain states, your spouse’s consent may be necessary if you wish to name a person other than or in addition to your spouse as beneficiary or to change an existing beneficiary designation. You should consult with your attorney before making such a beneficiary designation.
    • What happens when I terminate employment?
      If you change employers or leave the work force, the HSA stays with you rather than with your former employer. The account information will remain the same, however new fees may apply for these independent accounts.
    • What is a Health Savings Account?
      A Health Savings Account (“HSA”) is a tax-advantaged healthcare account created for the purpose of saving and paying for qualified medical expenses now and in the future. If you are enrolled in an HSA-compatible health plan, such as a high deductible health plan (HDHP), you can enroll in an HSA. The maximum HSA contribution is established by the IRS and is subject to change annually. The funds contributed to an HSA will rollover and accumulate year to year if not used. In addition, an HSA is portable, which means if you change employers or leave the work force, the HSA stays with you. Finally, an HSA does not require you to submit documentation to substantiate your transactions; however, you should keep your receipts in the event of an IRS audit.
    • What is a qualified High Deductible Health Plan (HDHP)?
      A High Deductible Health Plan (HDHP) has a higher deductible than most health plans. With this type of plan, you must first pay a deductible. Once you pay the deductible, then the HDHP can pay claims. For a Health Savings Account (HSA), a qualified HDHP must meet the following criteria.
      1. Minimum Deductibles – A qualified HDHP must have minimum deductibles. If the plan has a deductible that is lower than this minimum, it is not a qualified plan for the HSA.
        • For 2014, the deductible for a self-only plan must be at least $1,250.  For a family plan the deductible must be at least $2,500.
        • For 2013, the minimum deductibles are $1,250 (self-only) and $2,500 (family).
      2. Limit on Out-of-Pocket Expenses – A qualified HDHP limits what you pay out of pocket in the plan year. This limit includes what you would pay for deductibles, co-payments and co-insurance. Note: These limits apply to in-network services only. The limits do not include what you pay for premiums, out-of-network services, expenses that the plan does not cover or amounts that exceed lifetime limits, if applicable.
        • For 2014, the out-of-pocket limit for a self-only plan is $6,350. For a family plan, the limit is $12,700.
        • For 2013, the out-of-pocket limits are $6,250 (self-only) and $12,500 (family).
      3. Preventive Care – The HDHP can cover preventive care while you are still meeting your deductible. The plan can cover preventive care at 100%. It may also require a co-pay or co-insurance for certain preventive services. Even though the plan covers preventive care, you would still be eligible to contribute to an HSA. Preventive care includes annual health exams, routine prenatal and well-child care, child and adult shots, stop-smoking programs, weight-loss programs and certain screening services.
      Note: The IRS sets these benefit limits each year. They may change from year to year based on a Cost-of-Living Adjustment (COLA).
    • What is an “excess contribution” and what happens if this occurs?
      A contribution made by you or your employer to an HSA that exceeds the amount allowed by law, or which is made during any year when you are not eligible to contribute, is called an “excess contribution.” Excess contributions including any income earned on the excess contributions should be removed from your HSA prior to filing your federal income tax return for that tax year. Excess contributions that are not removed will be subject to a 6% penalty tax each year the excess remains in the account. Please consult your tax advisor or accountant to determine the proper handling of excess contributions, since this may vary based on whether you or your employer are responsible for the excess, which tax year the excess was discovered and whether earnings were involved.
    • What is the tax treatment of an eligible individual’s HSA contributions?
      When you make an eligible contribution to an HSA, the amount of your contribution up to the maximum contribution limit is deductible in computing your adjusted gross income provided the contribution is not made through pre-tax payroll contributions. This means that your contributions are deductible whether or not you itemize deductions. In addition, any person who may be claimed as a dependent on another taxpayer’s return may not claim a deduction for a contribution to an HSA. A special rule applies to certain married individuals. If either spouse has family coverage under an HSA-compatible health plan, both spouses will be treated as having family coverage. The amount allowable as a deduction after application of this rule shall be divided equally between the spouses unless they agree on a different division. If you are contributing view pre-tax payroll contributions, you have already received the tax benefit and you do not deduct these amounts on your tax return.
    • What is a “catch-up” contribution?
      If you are enrolled in an HDHP and are age 55 or older, you can contribute another $1,000 annually to your HSA. This is a catch-up contribution. For example, you have a self-only HDHP. For 2014, the contribution limit is $3,300. If you are 55 or older, you can contribute up to $4,300 for the year. ($3,300 + $1,000) Note: This is assuming that you are eligible for the full year.

      If you have family HDHP coverage and your spouse is age 55 or older, he or she can also make a catch-up contribution of $1,000 annually. If your spouse wants to do this, he or she would have to open up his or her own HSA. Only one person can own an HSA. This means that your spouse cannot contribute his or her catch-up contribution to your HSA.

      Note: If you are eligible for benefits under Medicare you cannot make a contribution or catch-up contribution to an HSA.
    • What other types of health coverage can I maintain without losing eligibility to contribute to an HSA?
      You remain eligible to contribute to an HSA if, in addition to an HSA-compatible health plan, you have any one or more of the following: insurance under which substantially all of the coverage relates to liabilities from workers’ compensation laws, torts, or ownership or use of property (such as automobile insurance); insurance for a specified disease or illness; insurance paying a fixed amount per day (or other period) of hospitalization; or coverage (whether through insurance or otherwise) for accidents, disability, dental care, vision care, or long-term care. You may also have coverage under an Employee Assistance Program (“EAP”), and you may have a discount card that enables you to obtain discounts for health care services or products at managed care market rates.
    • When am I eligible for a Health Savings Account (HSA)?
      First, you must have a qualified High Deductible Health Plan (HDHP) to have an HSA. The date that you are eligible for the HSA is based on the effective date of your HDHP.
      • If your HDHP starts on the first day of the month then you are eligible for the HSA that same day. For example, the HDHP starts on January 1. You are eligible for the HSA on January 1.
      • If your HDHP starts on any day after the first day of the month, you are eligible for the HSA on the first day of the next month. Let’s look at an example. Your HDHP is starts on January 15. You are eligible for the HSA on February 1.
      Once you sign up for the HSA, you must go through a Customer Identification Process (CIP). With the CIP, we verify your name, Social Security number, address and date of birth. If we need more information from you, that could delay the opening of your HSA. Once your HSA opens, that is the effective date. So, your effective date may be later than the date you are eligible.
    • When am I subject to the 20% penalty tax?
      If you use your HSA funds for non-qualified medical expenses, those funds will be applied to your gross income and taxed accordingly. In addition, a penalty tax is applied when using your HSA funds for non-qualified medical expenses. The penalty tax does not apply to distributions made after your death, disability or attainment of age 65.
    • When can I receive distributions from an HSA?
      You can take a distribution from your HSA at any time. A transfer of funds from your HSA to another investment option made available through us is not considered a “distribution,” and remains part of your HSA custodial account.
    • When can I start to use my HSA?
      You can start to use your HSA once it is open and funded. Your effective date determines which expenses you can pay with the HSA funds. You can use your HSA funds for expenses that you incur on or after the HSA effective date. You can’t use the HSA for expenses that you incurred before the HSA opened.
    • When is the deadline for making contributions to an HSA for any particular year?
      You may make HSA contributions for a particular year no later than the deadline (without extensions) for filing your federal income tax return for that year. For calendar year taxpayers, this is generally April 15 following the year for which the contributions were made. However, your HSA custodian will treat any contribution made between January 1 and April 15 as a contribution for the current taxable year unless you provide written notice to the HSA custodian at the time of such contribution.
    • Who is eligible for an HSA?
      An eligible individual is one who (i) is covered under an HSA-compatible health plan as of the first day of the month, (ii) is not covered by any other health plan unless it is another HSA-compatible health plan, (iii) is Medicare eligible but not enrolled in Medicare, and (iv) may not be claimed as a dependent on another person’s tax return.
    • Who may contribute to an HSA?
      Any person (an eligible individual, an employer, a family member, or any other person) may make contributions to an HSA on behalf of an eligible individual.
    • Will I receive a statement of my account activity?
      Yes, you will receive statements showing your account activity. You may elect to receive your statements electronically or via US Mail.
  • HH - Commuter Benefits (online ordering platform)
    • Can I cancel my pass at any time during the month?
      Ordered passes and recurring order passes may be cancelled before the cycle close date. During the order cycle, transit orders placed are listed under the “pending” tab of the transit website.
    • Can I order the exact pass I use now?
      We offer more than 10,000 different types of tickets and passes and most likely, we have exactly what meets your transit or parking needs. If you cannot find your provider, simply select the “click here” link located on the transit order screen. You can provide us with your transit pass information and you will be notified within 10 business days on the status of your request.
    • Do I have to go online every month to purchase my transit pass?
      When you make your online purchase you have the option to schedule it as an automatically recurring transaction. If you choose this option, your purchase will be automatically placed monthly so you do not need to go back online unless you need to make a change or cancel your recurring purchase for a particular month.
    • Do I need to submit any receipts for transit passes?
      You do not need to submit any receipts when you order your transit passes online.
    • How can I save money with this program?
      If you enroll in a Commuter Benefits online program, you are not required to pay income, Social Security or FICA taxes on money that is used to pay for commuting expenses, up to the IRS limit. Therefore, assuming a combined tax rate of 30% and an election of $130/month for transit expenses, you can save more than $468 per year. If you elect the maximum of $250/month for parking, you can save another $900 per year on parking expenses. 
    • How do I purchase my transit pass online?
      Login to your HealthHub account and select Commuter Benefits on the left navigation bar to get started.
    • How do I submit a parking order online?
      There are three parking options available to you online. You may choose Monthly Direct Pay, Commuter Checks for Parking or Cash Reimbursement.
    • What are the monthly pre-tax limits?
      For 2013, the pretax limit for parking expenses is $245 per month and the combined limit for transit and vanpool is also $245 per month.  For 2014, the pretax limit for parking expenses will be $250 per month and the combined limit for transit and vanpool will be $130 per month. These limits are set by the Federal government and are generally adjusted on an annual basis. 
    • What do I do if my address changes?
      If you have a change of address, please provide your new address to your employer immediately. HealthHub only accepts address changes from your employer. This address is where your pass will be mailed. You cannot change your mailing address online or by calling our call center.
    • What expenses are eligible for this pre-tax benefit?
      Public transportation, vanpools, carpools or commuter highway vehicles, as well as parking at or near your place of employment are all eligible pre-tax expenses. In addition, parking at a location from where you commute to work by public transit, vanpool or carpool, is also a qualified expense.

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

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

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

    • When can I purchase my transit pass or monthly parking online?
      Monthly purchase cycles vary by employer and can run from the 21st of one month until the 10th of the following month.
    • When will I receive my transit pass?
      Your transit pass will arrive at your home address before the 1st of the benefit month. Funds will be loaded and available on the Stored Value Transit Cards (e.g. Chicago Card, MetroCard, etc. by 12:01 am on the 1st of the benefit month.
    • When will my parking location receive my monthly payment?
      Parking garages and lots are paid at the end of each month for the following months’ use. In rare instances where payment cannot be made to the lot directly, you will receive the payment directly which can then be given to the parking provider.
  • HH - Commuter Benefits (reimbursement account solution)
    • Can I enroll at any time?
      You can enroll at any time during the plan year to begin participation starting the beginning of the next month. Please check with your Human Resources/Benefits Department for additional details.
    • Do I need to keep my receipts?
      Yes, each time you pay for work-related parking and/or transportation, you must keep the receipt of the expense to be reimbursed. There may be times where a receipt is not provided for your parking & transit expenses. In this case, submit a claim and note that no receipt was provided.
    • How do I file a claim?
      Login to your HealthHub account and select File a Claim to get started.
    • How does a reimbursement account work with Commuter Benefits?
      A reimbursement account for Commuter Benefits, also referred to as a Transportation Spending Account (TSA), allows you to put aside money on a pretax basis to pay for work-related commuting and parking expenses. It is an employer sponsored plan that is endorsed by Section 132 of the Internal Revenue Code. If offered by your employer, it may consist of two separate benefits, parking and transportation. If your employer offers this benefit and you elect to participate, you may elect a monthly contribution which will be taken out of your paycheck on a pretax basis in equal amounts. This money will be available to pay for eligible work-related transit and parking expenses based on claims submitted.

      • For 2013, the maximum election for parking is $245 per month and the maximum election for transit is $245 per month. A commuter who incurs both transportation and parking expenses is eligible to contribute a total of $490 per month on a pretax basis with up to $245/month applied toward parking and $245/month applied towards transit/vanpooling.
      • For 2014, the maximum election for parking is $250 per month and the maximum election for transit is $130 per month.  A commuter who incurs both transportation and parking expenses is eligible to contribute a total of $380 per month on a pretax basis with up to $250/month applied toward parking and $130/month applied towards transit/vanpooling.
      • You can submit claims for parking and qualified transit expenses incurred during the calendar year and you will be reimbursed up to the limits allowed by the IRS on a monthly basis.
      • Reimbursements for your parking and/or transit expenses can be deposited directly into your bank account.
    • How does paying for my commute with pre-tax dollars save me money?
      The program allows you to pay for your commuting expenses before Federal, state and local taxes are taken out of your paycheck by your employer. Paying with pre-tax dollars decreases your taxable income and, therefore, you pay less in taxes.
    • How often can I change my election?
      Typically you may change your election on a monthly basis. Please check with your Human Resources/Benefits Department for additional details.
    • If I couldn’t use my PayFlex Card® to purchase my transit pass, can I submit a claim to PayFlex® for reimbursement?
      If your employer allows a cash reimbursement option, then you may submit a claim to PayFlex® for reimbursement.
    • If I do not use the money in my transportation account, will I lose it?
      This depends on how your Employer’s plan is set up. Please check with your Human Resources/Benefits Department for additional details on your specific plan.
    • May I use my PayFlex Card® for transit expenses?
      If your employer offers the PayFlex Card® for transit expenses and you have elected to participate in the transportation spending account, then you may use your PayFlex Card® to pay for your transit passes/vouchers.
    • What commuting expenses are eligible for this pre-tax benefit?
      Eligible transportation services include subways, buses, ferries, commuter rail, carpools and vanpools.

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

    • What is considered a valid receipt?
      A valid receipt should have the merchant name, date, amount of expense and a description of the purchase for a transportation pass or parking.
    • What should I do if I try to use my PayFlex Card® and the transaction is denied?
      If you try to use your PayFlex Card® to purchase a transit pass and your transaction is denied, please make sure that you have confirmed your available balance and that you have enough funds for the purchase.
  • Healthcare FSA Claim Tips
    • Can I pay my spouse's health insurance premiums through my 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.
    • My employment terminated during the plan year. Do I still have the grace period?
      No, you must be an active participant on the last day of the plan year in order to be able to incur expenses during the grace period.
    • What if I still have money in my account after the end of the grace period?
      Once the grace period ends, any remaining balance will be forfeited. The grace period is offered by your employer to help you avoid forfeiting your money by allowing an additional 2½ months to incur eligible expenses.
    • What is a grace period?
      A grace period extends the time that you are allowed to incur eligible healthcare and/or dependent day care expenses. For a calendar plan year, the timeframe would usually begin January 1 and end on December 31. However with a grace period, you will have an additional 2 ½ months beyond December 31, therefore allowing you to incur expenses up until March 15 of the following year. In other words, you will have a total of 14 ½ months to utilize your 12 month election. Any amount not used by the end of the grace period will be forfeited.
  • 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.
  • If Your Employer Offers the PayFlex Card for Commuting Expenses
    • I am using my PayFlex Card® at a transit station but the transaction was denied. Why?
      You should be able to use your PayFlex Card® at transit station kiosks and ticket windows, however, you may not be able to use the card at merchant stands in the transit station that sell newspapers and food items in addition to transit passes. Your PayFlex Card® will only be accepted at credit card machines that only sell transit passes.
    • If I couldn’t use my PayFlex Card® to purchase my transit pass, can I submit a claim to PayFlex® for reimbursement?
      If your employer allows a cash reimbursement option, then you may submit a claim to PayFlex® for reimbursement.
    • May I use my PayFlex Card® for transit expenses?
      If your employer offers the PayFlex Card® for transit expenses and you have elected to participate in the transportation spending account, then you may use your PayFlex Card® to pay for your transit passes/vouchers.
    • What should I do if I try to use my PayFlex Card® and the transaction is denied?
      If you try to use your PayFlex Card® to purchase a transit pass and your transaction is denied, please make sure that you have confirmed your available balance and that you have enough funds for the purchase. In addition, you will want to confirm that the vendor/credit card machine you are attempting to use sells only transit products. You should be able to use your PayFlex Card® at transit station kiosks and ticket windows, however, you may not be able to use the card at merchant stands in the transit station that sell newspapers and food items in addition to transit passes.
    • Where can I use my PayFlex Card® as of January 1, 2011?
      You may use your PayFlex Card® at locations and vendors that sell only transit passes. This would include ticket windows and kiosks at transit stations. The PayFlex Card® will not work at any location that sells other types of products in addition to transit passes, even if you are able to purchase transit passes at that location. This is an IRS restriction.
  • Dependent Day Care FSA Claim Tips
    • I just had a new baby and will be home for six weeks. I'm taking my 3-year-old to day care during this time. Will these day care expenses be eligible?
      IRS regulations state that the dependent day care expenses incurred must be due to work-related purposes; therefore, these dependent day care expenses are technically not reimbursable.
    • I pay my neighbor to watch my 13-year-old after school. Is this after-school care considered an eligible expense?
      This would not be considered an eligible expense because the individual being cared for must meet the “qualifying person test” as described by the IRS. A qualifying person includes your dependent who is under age 13 and regularly spends at least eight hours each day in your home.
    • I signed up to contribute $400 per month into my Dependent Day Care Flexible Spending Account (FSA) but my actual expenses are closer to $500 per month. Should I submit my claim form for $400 or for $500?
      You can file your claim for the actual amount of charges, in this case $500. However, you will only be paid up to the amount of money available in your account, not to exceed $400. The remaining $100 would be pending until additional funds are deposited into your account.
    • My 16-year-old daughter cares for my 8-year-old son after school. Can I pay my daughter and file those expenses through my Dependent Day Care FSA?
      No. You can only count work-related payments you make to relatives if they are not your dependents. You cannot claim amounts you pay to:
      • A dependent for which you or your spouse, if married, can claim an exemption.
      • Your child who is under age 19 at the end of the year, even if he or she is not your dependent. (See IRS Publication 503).
    • My child just started kindergarten for which I pay tuition. Is this an eligible dependent day care expense?
      The IRS does not consider educational or tuition expenses as eligible expenses, including kindergarten, first grade and higher. However, you can claim expenses for before and/or after-school care provided the care is custodial in nature and not educational.
    • What are the requirements for getting reimbursed for dependent day care expenses?
      • You and your spouse, if married, must be earning an income, seeking employment, or a full-time student in order to receive the pre-tax benefits of a Dependent Day Care FSA. Please note; volunteer work or working for a nominal salary is not an acceptable form of employment.
      • The expenses must be for a qualifying individual. This includes a dependent of yours younger than age 13, a spouse or another dependent who is physically or mentally incapable of self-care and for whom you can claim an exemption.
      • The services must be provided by an eligible provider of child care. This includes a licensed child care facility that complies with applicable state and local laws and any individual who is not your tax dependent or is your child who is 19 or older.
      • The expense must be for services already received and not services to be provided in the future.

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

      • The annual expense reimbursement may not exceed the lesser of:
        • Your earned income;
        • If married, your spouse’s earned income; or,
        • $5,000 ($2,500 if married, filing separate income tax return).
      • You must file Form 2441 annually with your individual tax return identifying all dependent care providers
    • What expenses are considered eligible expenses under a Dependent Day Care FSA?
      For a listing of eligible expenses, visit 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 health care claim(s)?
      Acceptable documentation consists of one of the following:
      • An Explanation of Benefits (EOB) is our preferred form of documentation, which is provided to you by your insurance provider.
      • An itemized receipt is also acceptable, but it must show the date of purchase or service, amount of purchase or service, description of item or service, name of merchant or service provider, and name of patient if a medical claim.
      • Prescription drug receipt containing the pharmacy name, patient name, date the prescription was filled, the name of the drug, and dollar amount.
      • Over-the-counter (OTC) items must be clearly described on the receipt. 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.

 
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