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Frequently Asked Questions
  • Health Care Flexible Spending Account (FSA)
    • *Note: This information is general in nature for informational purposes only. Please refer to your employer’s plan for specific information about your plan.
      Do I have to enroll in my employer’s medical or dental plan to participate in the health care FSA?
      Your plan will determine this. Although your employer can require that you take the medical or dental plan in order to have a health care FSA, not all plans are designed this way. You should check your plan documents to confirm this. 
       
      I have a health care FSA. If I’m contributing throughout the year, how much will my FSA cover for a claim in the beginning of the year?
      With a health care FSA, your full election amount is available on the first day of the plan year. This means that you can use your entire election on day one of the plan year.
       
      Example: You elect to contribute $1,200 for the plan year. In January, you have contributed $100. ($100 x 12 months = $1,200) In that same month, you receive health care services that cost you $1,000. At this point, you haven’t submitted any other claims. This means, you’ll receive the full amount of the claim from your FSA. You don’t have to wait until you actually contribute this amount to your health care FSA.
       
      What expenses are eligible under a health care FSA? 
      Generally, expenses that are medically necessary are considered eligible. This means if you need the service or product for your health it may be an eligible expense. This includes co-payments, co-insurance and deductibles. You can view a list of common eligible expenses on this website. You can also find more information at www.irs.gov. Refer to IRS Publications 969 and 502. You should also check your plan documents for eligible expenses under your plan.
       
      Can I use my FSA to pay for over-the-counter (OTC) items, supplies, drugs and medicines?
      Yes. However, there are different rules on how you can use your FSA to pay OTC items, supplies, drugs and medicines. You can use your PayFlex Card® to pay for OTC items and supplies. These include items such as bandages, hot/cold packs, thermometers, first aid kits, home diagnostic tests and diabetic supplies. You can also pay for these items out of pocket and then submit a claim to us. 
       
      For OTC drugs and medicines, you can’t use your PayFlex Card. First, you’ll need a written prescription from your doctor. Then you’ll have to pay for the OTC drug or medicine out of pocket and then submit a claim to us. You’ll need to include your written prescription and the detailed receipt with your claim.
       
      May I submit eligible health care expenses incurred by my spouse and dependents?
      Yes. You can be reimbursed for eligible health care expenses that you, your spouse and eligible tax dependents incur during the plan year. This is true even if you don’t cover your spouse and dependents on your health plan.
       
      Why do I have to show that an expense was medically necessary?
      There are some products or services that aren’t always used for medical care. Some products may be used for general health reasons. Two examples are massage therapy and weight loss programs. If you use the product or service to treat a medical condition, you’ll need to show that. This is “evidence of medical necessity.” You can submit a prescription or letter from your health care provider. You can also have your health care provider complete and sign a Letter of Medical Necessity form. You can find this form in the Resource Center.
       
      Can I pay my spouse’s health insurance premiums through my health care FSA?
      No. Premiums aren’t an eligible expense for the health care FSA. You can view a list of common eligible expenses on this website. For more information, visit www.irs.gov. There you can view IRS Publications 969 and 502.
  • My PayFlex Card®
    • Note: This information is general in nature for informational purposes only. Please refer to your employer’s plan for specific information about your plan.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      • 24/7 access to MasterCard’s certified resolution specialists
      • Internet monitoring to proactively detect stolen personally identifiable information and compromised confidential data online
      • Assistance from a specialist with notification to all three major credit reporting agencies to place blocks on cardholders’ records and obtain free credit reports
      • Assistance with completing paperwork to alert various parties of the potential fraud
      • Education about how identity theft can occur and protective measures to avoid further occurrences
      To learn more about the Identity Theft Resolution Services, call the MasterCard Assistance Center at 1-800-MC-ASSIST (1-800-622-7747).

      MasterCard® is a registered trademark of MasterCard International Incorporated.
    • What is a PayFlex Card?

      Your PayFlex Card is a MasterCard®  debit card that may be used to pay for eligible health care expenses, rather than paying out of pocket and being reimbursed.

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

      • Immediate payment of your expenses from your healthcare account
      • Increased personal cash flow
      • Reduces the amount of paper claim filing
      • Ease of use of your pre-tax funds

      How does my PayFlex Card® work?
      As you incur eligible healthcare expenses, you can use your PayFlex Card as a form of payment. All you have to do is swipe your card and select “Credit.” If you are paying for services or items from a healthcare-related merchant such as the doctor’s office, or one that has implemented an inventory information approval system (IIAS) such as a pharmacy, your transaction will generally be approved at the point of sale. However, you should always keep your itemized receipts and Explanation of Benefits (EOB) from all purchases and services in the event that you need to provide them to the IRS.

      If you purchase eligible healthcare 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 your health care FSA expenses incurred during the plan year.

      Should I select “debit” or “credit” when using my PayFlex Card?
      Always select the “credit” option when using your PayFlex Card.

      Where can I use my PayFlex Card?
      Your PayFlex Card is generally 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 IIAS  certified merchants must accept MasterCard® in order for your card to work.

      When you use your PayFlex Card at IIAS certified  merchants, eligible healthcare expenses will be automatically approved when scanned at the pharmacy counter.  You won’t need to send receipts or other documentation for those items.

      View a listing of merchants that accept your PayFlex Card.

      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.

      Can I buy over-the-counter (OTC) items with the card?
      Certain OTC medicines and supplies 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 see Planning Tools.

      After December 31, 2010, 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.  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 see 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.

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

      Where can I see a summary of my PayFlex Card transactions?
      A statement including your PayFlex Card transactions is only available online. Login to your HealthHub account and select Financial Center on the top navigation bar. Then select an account from the drop down menu to view your recent transactions.

      How do I access my account information & view my PayFlex Card® transactions online?
      You can get to your HealthHub account via Single Sign On from the Omnicom Group Health and Welfare website at, www.ibenefitcenter.com/omnicom. Click on "Manage your FSA" in the Take Action section on the Health and Welfare Benefits page 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.

      Why isn't my PayFlex Card working?
      If your card is not working, it could be one of the following reasons:
       

      • Your card has expired. (You will be sent a replacement card two weeks prior to expiration.)
      • 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, or their card reader has not been set up correctly.
      • You are using an invalid merchant – the merchant does not accept MasterCard® or has not implemented an inventory information approval system

      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:

      OPTION #1: Use another form of payment to purchase your healthcare item and submit a claim for reimbursement.
      OPTION #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 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 healthcare card is an eligible or ineligible healthcare expense according to IRS Section 213(d) (the IRS rules on eligible items). An IIAS is required at merchants such as drug stores, pharmacies, grocery stores, hospitals, etc. in order for healthcare cards to be accepted for eligible items.
       

      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 healthcare expenses from that location with another form of payment and submit a claim for reimbursement.

      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 a prior eligible expense. Login to your HealthHub 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 or call us to determine the cause at 800-752-8233.

      Why did I receive a Request for Documentation letter for my expense?
      The PayFlex Card is set up to approve copayments that match your employers’ Insurance plan. Most likely you received this letter because your expense did not match your employer’s insurance 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 expenses that fall under the ineligible category such as cosmetic procedures. Therefore, PayFlex is required to make sure that you are not using your healthcare dollars for ineligible expenses.

      Please note, that although your expenses may be clearly associated to a medical, dental, or vision provider, 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.

      Can I use my PayFlex Card™ for dental expenses?
      Yes, you can use the PayFlex Card for dental expenses.  However, you can only use it for the amount of the dental expense that is not covered by insurance. According to the IRS, expenses paid by another source, such as insurance, cannot be reimbursed through your healthcare account as well. It is best to wait until you receive the final amount from your insurance provider stating your financial responsibility to pay your provider. Using the PayFlex Card to pay for your dental expenses before your insurance provider has determined the amount of your financial responsibility could result in an overpayment from your healthcare account.

      For example: If your dentist uses an "estimated" or "pending" amount to determine your expense, instead of the actual amount as determined by your insurance provider, and you pay that amount with the PayFlex Card, the dentist may have overcharged your account, resulting in an overpayment. This happens if your healthcare account paid for a portion of your dental charges that might also be paid by insurance.  This will put your healthcare account in an “overpayment status”.  To resolve an overpayment, you must send a check to PayFlex® for the overpayment amount OR submit a claim for another eligible expense that was purchased with a form of payment other than your PayFlex Card
       

      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.
       

      What happens if I have a $1,000 balance in my FSA and I use my PayFlex Card® to pay for a $1,500 healthcare 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.

      How do I report a lost or stolen card?
      Contact us as soon as possible to report a lost or stolen card. If the loss of a card is reported within 30 days, you are not liable for any fraudulent charges. You may contact PayFlex at 800-284-4885 to report a lost or stolen card.

  • Managing My Settings
    • How do I enroll in direct deposit?
      • Login to your HealthHub 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 change my username and password?
      Login to your HealthHub account and select My Settings on the left navigation bar to get started.
       

      What is eNotify™ and how do I enroll in it?
      eNotify™ is HealthHub’s electronic notification service that is used to provide updates on your account balance (Balance Reminder), notifies you when your claim has been received (Claim Received) and when it has been processed (Explanation of Payment), and alerts you when additional documentation is needed for your PayFlex Card® transactions (Receipt Request Letter). You choose which notifications you want to receive as well as when and how you want to receive them.

      To enroll in eNotify™, login to your HealthHub account 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.

  • Filing A Claim
    • How do I file an FSA claim?
      After you incur an eligible expense, you can:
      • Submit a claim online. You can upload or fax your documentation to us.
      • Submit a claim using the PayFlex Mobile® app. You can download it for free* from your mobile app store. You’ll use the same username and password that you use for this website.
      • Complete a paper claim form and mail or fax it with your documentation. You can find this form in the Resource Center.
      *Standard text messaging and other rates from your wireless carrier still apply.   

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

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

      If your expense didn’t go through your medical or dental plan, you can send an itemized receipt or statement for the expense. It must show the:
      • Date of service or purchase
      • Amount you were required to pay
      • Description of the item or service
      • Name of the merchant or provider
      If the claim is for an over the counter (OTC) drug or medicine, you must also include a written prescription from your doctor.

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

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

      Note: If you don’t send an EOB, itemized receipt or statement with your claim, we’ll deny it. We can’t accept a cancelled check, credit card receipt, or billing statement that shows “previous balance,” “balance forward,” “estimated,” “filed,” or “pending insurance.”
    • 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 file a claim online, select File a Claim on the left navigation bar and follow the easy steps. To print a paper claim form, click on Resource Center and then see Administrative Forms.
       

      What type of documentation is acceptable to submit for reimbursement of healthcare claim(s)?

      • An Explanation of Benefits (EOB) is our preferred form of documentation, which is provided to you by your insurance provider.
      • A summarized statement from your insurance provider that shows: Date of Service, Service Description, Provider, Final Patient Responsibility, Employee Name, Patient Name (List required pieces of information.)
      • 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. Certain OTC drugs and medicines will require a prescription from your physician in order to get reimbursed.

      Please note that a cancelled check is not acceptable documentation.

      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 healthcare or dependent 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 healthcare 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 is an Overpayment and how do I resolve it?
    • What does overpayment status mean?
      Overpayment status occurs when you have used the PayFlex Card® to pay for a medical, dental, or vision expense and the documentation does not support the amount paid.  For example, if you use your PayFlex Card to pay for a bill that exceeds your final patient responsibility, your account will go into overpayment status OR if you submit an itemized statement from the provider 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®.

      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 My Dashboard under Alerts.  In addition, if you are enrolled in the email option for eNotify (PayFlex’s electronic notification service), you will receive an Explanation of Benefits for overpayment to your business email address, sent from eNotify@payflex.com.  If you do not select the email option for Explanation of Benefits notices, PayFlex will mail monthly  notices to your home address on file to advise you of any needed substantiation.  All documents will be stored online, in case you misplace the notice.
      • Access your Explanation of Payments online 
        To view and/or download notices, go to omnicom.HealthHub.com or login to www.ibenefitcenter.com/omnicom and click on “Manager your FSA” in the Take Action section on the Health and Welfare Benefits page. When you have landed on My Dashboard, then  select My Documents from the left hand navigation bar andselect Coupon with EOB Report from the drop down menu.  If your account is in overpayment, you will see the Explanation of Payments 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.ibenefitcenter.com/omnicom, click on “Manager your FSA” in the Take Action Container on the Health and Welfare Benefits page, and select My Settings once you have landed at Omnicom.Heathhub.com Then click on Manage Notifications, and select the notifications you wish to receive either via email or web alert.  To save your changes, click Submit.

      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.

      I used my PayFlex Card to pay for my medical, dental, or vision expenses and my provider overcharged me.  Who is responsible for fixing this issue?
      If you were overcharged by your provider, 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 which will be applied towards the overpayment on your PayFlex account.

      I received a bill from my provider 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 my provide and it was approved.  Why am I receiving a Request for Documentation letter for my 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.

      What is the difference between an Explanation of Payment (EOP) from PayFlex and an Explanation of Benefits from my insurance provider?
      An Explanation of Payment from PayFlex is a document notifying you what FSA claims have been approved for reimbursement, denied, or whether your account is in overpayment status.  An Explanation of Benefits from an insurance provider is a statement which details what services have been paid by the insurance plan and what is owed to the provider by the insured individual.
       

  • Dependent Care FSA Claim Tips
    • What expenses are considered eligible expenses under a dependent care FSA?

      For a listing of eligible expenses, click on Eligible Expense Items from the Quick Links section, or visit Resource Center and see Planning Tools. For more information, please refer to IRS Publication 503.

      What are the requirements for getting reimbursed for dependent 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 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:
        o Your earned income;
        o If married, your spouse’s earned income; or,
        o $5,000 ($2,500 if married, filing separate income tax return).
        o You must file Form 2441 annually with your individual tax return identifying all dependent care providers
      When can I submit a claim for my dependent care expenses?
      Dependent care claims should only be submitted following the completed dates of service.

      What if my dependent 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 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 care expenses?
      Acceptable documentation consists of one of the following:

      • A completed dependent 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 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.

      I signed up for a dependent care FSA and my monthly contributions are $400 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 child just started kindergarten for which I pay tuition. Is this an eligible dependent 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 and a detailed receipt is provided that clearly indicates these expenses with your claim submission.

      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 pay my neighbor to watch my 11-year-old after school. Is this after-school care considered an eligible expense?
      This would be considered and eligible expense because the individual being cared for meet the “qualifying person test” as prescribed by the IRS.  A qualifying person includes your dependent who is under age 13 and regularly spend at least eight hours each day in your home.

      Note: 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.
       

      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 care expenses incurred must be due to work-related purposes; therefore, these dependent care expenses are not reimbursable.
       

      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 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).
  • Run out Period
    • What is a "run out period"?
      A run out period is the period of time you have to file claims incurred during the plan year and is typically 90 days after your plan year ends. Your plan year runs from January 1 through December 31, so you  have until March 31 of the next year to file claims incurred between January 1 and December 31.

      What happens to my Dependent Care FSA if I terminate from my employment?
      You may incur and claim expenses for any unused deposits in your dependent care account through the end of the plan year. This can help pay for care if you have a job interview or other qualified expenses.

      What happens to my Healthcare FSA if I terminate from my employment?
      You may continue to submit claims through the plan year runout period, only for eligible  expenses incurred prior to your termination date.  You may elect to continue your healthcare FSA under COBRA.
  • All About FSAs
    • What is Flexible Spending Account?

      A Flexible Spending Account (FSA) provides a tax-advantaged way to pay for eligible out-of-pocket healthcare expenses and work-related dependent 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 Healthcare FSA allows you to set aside money on a pre-tax basis to pay for qualifying out-of-pocket medical, dental, vision or hearing expenses. Out-of-pocket expenses are those that are not covered by your existing medical, dental and vision coverage. These expenses include deductibles, coinsurance and co-pays, prescription drugs and certain over-the-counter (OTC) expenses.

      A Dependent Care FSA allows you to set aside money on a pre-tax basis to pay for child or certain adult 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 care.

      An 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.

      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 healthcare expenses and/or dependent care expenses during the plan year.
      2. Decide how much you wish to set aside into your Healthcare 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 healthcare 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.

      Is there a maximum that I can contribute to a Health Care FSA?
      Yes. Omnicom's Health Care Flexible Spending Account (FSA) annual maximum contribution amount is $2,550. 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. 

      How do I get reimbursed?
      As you incur eligible healthcare and/or dependent care expenses throughout the year, you can access your funds by using your PayFlex Card for eligible health care expenses or get reimbursed by submitting a claim.

      When might it not be advantageous to enroll in an FSA?
      Your plan has a minimum annual contribution amount of $150.00. If you do not expect to have eligible expenses that reach that amount, you may not want to enroll in an FSA.

      If you do not have predictable out of pocket medical expenses, you would not want to risk incurring forfeitures so you most likely would not want to enroll. With respect to the dependent care FSA, if you are married and your spouse does not have earned income or is not a full-time student or you do not have custody of the child, you are generally not eligible to participate in a dependent care FSA and should not enroll.

      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. Visit Omnicom Health and Welfare Benefits website online at: www.ibenefitcenter.com/omnicom and click on Qualified Status Change on the Health and Welfare Benefits home page.
       

      What happens to the funds left in my account at the end of the plan year?
      Any remaining balance left in your account after all your claim submissions have been processed for the plan year  is forfeited. 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.

      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%.  Your total tax savings will depend on your state of residence.

      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.

      What happens if I leave my company or my employment is terminated?

      • Upon termination of employment, you may continue to submit healthcare claims incurred prior to termination and up to the amount of your annual contribution. For dependent care, you may submit claims incurred up to and beyond your termination date up to the amount of the balance in your account at the time of your termination.
      • If you are eligible for COBRA upon termination of employment, you may continue your health care flexible spending account on a self pay basis for the same coverage that you had before termination. You may continue only for the remainder of the Plan Year in which your termination took place. You may not continue this coverage in to the next Plan Year.

      If you have had a qualifying event, visit the Omnicom Health and Welfare Benefits website online at:www.ibenefitcenter.com/omnicom and click on Qualified Status Change on the Health and Welfare Benefits home page.

      If my spouse and I are employed by the same employer, can we claim each other's expenses on our respective accounts?
      Generally, 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.”

      What expenses are considered eligible expenses under a dependent care FSA?
      For a listing of eligible expenses, visit Resource Center and see Planning Tools. For more information, please refer to IRS Publication 503.

      If I participate in the dependent 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.

      Is there a maximum that I can contribute to a dependent care FSA?
      Yes, the IRS maximum is currently $5,000 per household per plan year.  You may want to review IRS Publication 969 or consult your tax advisor if you and your spouse intend to make an FSA election.
       

      My enrollment material says that dependent care expenses must be "work-related." What does "work-related" mean?
      Work-related means that the expenses must be incurred to care for your eligible dependents 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.
       

      If you or your spouse are enrolled in higher education full-time, you may also be eligible for the Dependent Care FSA. Please refer to IRS Publication 503.

      If I use the dependent care FSA, can I also use the federal tax credit for dependent care expenses?
      Yes, however you cannot use a Dependent Care FSA and take a tax credit on your tax form for the same dependent 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 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. Please consult your tax advisor if you have specific questions.

  • Healthcare FSA Claim Tips
    • 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.

      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 Resource Center, 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 2012 and 2013. In October 2012, you sign an agreement with an orthodontist for your son. During the first visit (November 2012), your son is X-rayed and fitted for braces. On the second visit (December 2012), 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 2012.
       

      Can I be reimbursed the full $3,000 from my 2012 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 2012, the IRS regulations allow the healthcare FSA to reimburse you for the entire $3,000 as a 2012 expense.
       

      What if I do not have the full $3,000 remaining in my 2012 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).
       

      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 2012 and the orthodontist is charging you $3,000. On January 15, 2013, you decided to pay the lump sum amount.  You would be reimbursed from the 2013 FSA. (Note: the amount you are reimbursed cannot exceed the amount paid to the orthodontist or the total amount of your 2013 FSA goal amount.)


      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 with the orthodontist 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.

      Can I pay my spouse's health insurance premiums through my Healthcare 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 Healthcare Flexible Spending Accounts (FSAs).