Enrollment Information

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1 Enrllment Infrmatin IU HEALTH LA PORTE HOSPITAL FLEXIBLE SPENDING ACCOUNT DEBIT CARD GUIDE Effective: January 1, 2013 HEALTHSMART BENEFIT SOLUTIONS, INC.

2 Table f Cntents Intrducing Yur FSA Debit Card Examples Using Yur Benny Card General Infrmatin Over-the-Cunter (OTC) Inventry Apprved Standards List f Merchants Accepting Yur FSA Debit Card Online Benny Card Instructins... 6 Repayment f Ineligible Expenses Helpful Tips Enrllment Infrmatin Flexible Benefits Plan 1 BBenny

3 Intrducing Yur FSA Debit Card Yu already knw that Flexible Spending Accunts (FSAs) are tax smart. Nw when yu enrll in yur emplyer spnsred healthcare Flexible Spending Accunt Plan, yu will receive savings and cnvenience. Yur Benny Visa Card In ur effrts t bring yu the latest technlgy and service, yu will receive yur wn Benny card that makes using yur Flexible Spending Accunt dllars even easier. The Benny card is like a debit card in that it electrnically accesses funds held in yur Flexible Spending Accunt, and reduces the need t pay cash up frnt, submit paper claims and then wait fr reimbursement. An Enhanced Way T Use Yur FSA Yu enrll in the FSA benefit prgram during pen enrllment, and yur elected healthcare and/r dependent care cntributins will be deducted frm yur paycheck as usual. After yur enrllment has been prcessed, yu will receive tw Benny cards and an Agreement detailing all terms and cnditins fr use f the card in the mail. Yu shuld read and keep these materials fr reference, then sign the back f the card. A third card may als be rdered fr an additinal $10 that will be charged t yur Flexible Spending Accunt. Yur FSA Debit Cards will arrive in an envelpe with the Benny Man character n the frnt and very few ther identifying marks fr yur prtectin. Please activate yur card as sn as pssible. T activate, have the Benny card with yu and call the tll free number n the sticker attached t the card. Yu will be asked fr the last fur digits f yur Scial Security Number upn activatin. Yu nly need t activate ne f the cards, and this must be dne by phne. Once activated, the card is immediately available fr use. Activating the card nline is nt available. When yu seek healthcare services, yu shuld present yur medical insurance card first. Then, fr qualified services nt cvered by yur medical insurance, (cpayments, deductibles, etc.), yu shuld present yur Benny card. Each time yur card is swiped, the FSA system checks the VISA merchant categry cde (MCC) that is laded int the card machine. The MCC must match the list f IRS apprved MCC s in rder t be accepted. (In general, dctr s ffices, hspitals and dental ffices are n the IRS apprved list). Enrllment Infrmatin Flexible Benefits Plan 2

4 The system als checks yur FSA balance (annual electin minus pending and paid claims) t ensure that yur purchase des nt exceed the balance in yur accunt. Upn apprval, the prvider will be paid directly. It is very imprtant that yu save all receipts as yur FSA plan administratr, HealthSmart may request them t verify expense eligibility. Of curse, if yu chse nt t use the Benny card fr eligible healthcare expenses, reimbursements will cntinue t be made using the traditinal FSA claim reimbursement frm. Examples Using Yur Benny Card Example 1: C-pays Let s say yur medical insurance has a $25 c pay fr ffice visits. Yu have tw children that see their pediatrician fr an ffice visit. After receiving care, yu wuld first present yur insurance card t cver the cst f the ffice visit. Next, yu wuld present yur Benny card t cver yur cpayments. The same prcess wuld hld true fr visin, dental and hearing care prviders; specialist healthcare ffice visits; and medical clinics and hspitals (including emergency rms). Enrllment Infrmatin Flexible Benefits Plan Example 2: Prescriptins Under this scenari, assume yu have an RX card fr yur prescriptin cverage and yur plan has a $30 cpay fr prescriptins. Yu get a prescriptin filled at a lcal drug stre and pick up a few additinal items such as ltin and vitamins. First, present yur RX card at the pharmacy cunter. If the stre and the pharmacy cunter have implemented inventry cntrl standards required by the IRS, yu wuld als present yur Benny card. Items that are cded as FSA eligible wuld be prcessed n the Benny card and items that are nt FSA eligible wuld require a secnd frm f payment. Fr these pharmacies, there is n lnger the need fr yu t determine what is eligible and nn eligible. Hwever, if yur pharmacy has nt implemented the IRS inventry cntrl standards, the pharmacy will decline yur Benny card and yu will have t pay fr all items using anther frm f payment. Yu can still receive reimbursement fr these eligible items, but yu must submit a paper claim. A list f stres and pharmacies that have already implemented the IRS inventry apprved standards can be fund n page 6. If yu chse t take advantage f a mail rder drug prgram, visit r call t verify that yur mail rder prescriptin drug prgram has adpted the inventry cntrl standards; therwise yur Benny card will be declined. 3

5 General Infrmatin Cncerning The Use Of Yur Benny Card While using the Benny card facilitates immediate prvider payment, it des nt eliminate paper cmpletely. Claims must still be reviewed fr eligibility under Sectin 125 f the Internal Revenue Cde. These IRS guidelines require submissin f third party dcumentatin (i.e., EOB statements, prvider receipts) t prve the expense was eligible fr tax free reimbursement even when yu use yur Benny card, unless: The expense matches yur emplyer s medical plan dctr ffice visit c pay, r The expense matches yur emplyer s pharmacy c pay Therefre, when purchasing all ther items with yur card (such as expenses that g twards yur deductible, visin expenses, dental expenses, ver the cunter items at the drug stre, etc.), yu may still be required t submit receipts t shw purchases are qualified expenses. This is an IRS requirement. Additinally, by signing and using yur Benny card yu agree t all the terms and cnditins assciated with the card. That means that each time the card is used, it will be used fr qualified healthcare expenses (described in the Agreement yu will receive with the card), and that yu have nt, nr will nt receive r seek reimbursement frm any ther surce. Yu take respnsibility fr all transactins f the card, including reimbursement f verpayments fr ineligible claims. The same prcess wuld hld true fr visin, dental and hearing care prviders, specialist healthcare ffice visits, medical clinics and hspitals, including emergency rms. Hwever, yu must keep all receipts as the plan administratr may request them t verify expense eligibility. This is nt a new requirement. The IRS has always required that yu keep cpies f yur receipts. Enrllment Infrmatin Flexible Benefits Plan 4

6 Over-The-Cunter Inventry Apprved Standards Prir t 2008, if yu purchased an ver the cunter (OTC) item at a grcery, department r drug stre there were very few inventry standards in place t verify eligible flexible spending items. Withut standards, participants were required t send in all receipts. The IRS is requiring the use f an Inventry Infrmatin Apprved System (IIAS) t be in place r yur lcal pharmacy and drug stre can earn mre than 90% f their revenues frm the eligible healthcare items (90% merchants). If a stre r lcatin des nt have these standards, the card will nt wrk. Purchases made at merchants n the 90% Rule Merchants List will require verificatin f eligibility, and yu may receive a letter requesting itemized receipts, s please save all receipts! Purchasing items at a lcatin that has adpted the standards will allw yu t purchase any item and at the checkut, it will autmatically identify eligible FSA items. If all the items yu are purchasing are FSA eligible, then yu nly need t present yur Benny card. If yu are purchasing additinal nn eligible items, yu will be asked fr anther frm f payment. Since the IRS has already apprved these standards, the need t send in any supprt dcumentatin has been eliminated. Hwever, it is an IRS requirement that yu keep yur receipts fr a perid f n less than 3 years. This requirement is true fr all ut f pcket medical expenses whether yu use the debit card r submit paper claims. It is imprtant t remember that if yu chse t shp at a stre that has nt adpted the inventry apprved standards, the card will be declined. Yu will still be able t purchase yur ver the cunter items, but yu will need t seek reimbursement by a paper claim submissin. Refer t page 6 fr a partial listing f stres that have adpted an IIAS. This list will cntinue t grw. Yu can check peridically n fr an updated, cmprehensive list f bth IIAS and 90% merchants. Enrllment Infrmatin Flexible Benefits Plan IIAS stands fr Inventry Infrmatin Apprved System. Additinal infrmatin can be fund in IRS Ntice r nline at: 02_IRB/ar09.html. 5

7 Merchants Accepting Yur FSA Debit Card *Nte: This is a partial listing. Fr a cmprehensive list f merchants and pharmacies currently accepting yur Flexible Spending Accunt debit card, please visit Cntacts Albertsn s SuperValu Big Y Fds CVS/Pharmacy Drugstre.cm Fd 4 Less Gilchrist Pharmacy Kerr Drug King Spers Krger Kwik Shp Laf n Jug Lngs Drugs Lucky's Macey s OSCO Owen s Pak n Save Fds Paradise Shp N Save Pavilins Pay Less Supermarkets Paysn Market Petersn Fdtwn Pick n Save Price Chpper Supermarkets Quik Stp Ralphs Safeway Sam s Club Save A Lt Savn Shaw's ShpK Shp N Save Shppers Fd & Pharmacy Shprite Smith s Fd & Drugs Star Market Stp & Shp Supermarket C. Target The RX Shppe Tm Thumb Tradewinds Marketplace Vns Walgreen s Wal Mart Stres Online Benny Card Instructins The first time yu visit mybenny.cm, yu will be asked t register. Yu will need yur Benny Visa Card in frnt f yu. Please fllw the directins n the screen. Yur Member ID is yur nine digit Scial Security Number withut the dashes. Once registered, yu will be able t chse yur wn passwrd r reset yur passwrd at any time. Enrllment Infrmatin Flexible Benefits Plan 6

8 Repayment Of Ineligible Expenses What happens if yu accidentally purchase an item that is later deemed ineligible? Yu will receive a letter r e mail stating that yur expense was nt a qualified FSA purchase and that yu are required t repay that amunt back t the Plan. The letter r will guide yu thrugh the repayment prcess. A persnal check r mney rder payable t yur Cmpany and mailed t HealthSmart will als be required. If yu fail t respnd, the Plan will either ffset future manual claims by the dllar amunt due r add taxable dllars t yur paycheck r W 2. Helpful Tips The fllwing are helpful hints, tips and reminders when using yur Benny card: Please remember that even thugh this card is legally cnsidered a debit card (because it is funded by yur FSA electin), the card shuld be swiped at the pint f sale as a credit card and thus will nt require a pin number. Yu will need t sign fr purchases (similar t ther credit cards), and yu cannt withdraw cash. Enrllment Infrmatin Flexible Benefits Plan The Benny card is a signature based card. Yur spuse may sign the back f the card even thugh yur name appears n the frnt. If yur address is n file, the request letter fr fllw up dcumentatin will be sent by . T prtect yur privacy, this infrmatin is passwrd prtected. Yur passwrd is the last fur digits f the number shwn n yur Benny card. Lst r destryed cards may be rerdered fr an additinal $10.00 fee that will be charged t yur Flexible Spending Accunt (FSA). Always, always keep yur healthcare receipts. Yur plan administratr may request receipts t verify that yur expenses meet IRS guidelines. If the merchant r service prvider des nt accept Visa debit cards, yu will need t use anther frm f payment and submit a claim fr reimbursement in a traditinal manner. 7

9 We hpe yu take advantage f this new FSA prgram feature and enjy the benefits f using yur Benny card. As always, HealthSmart is available t prvide assistance and answer any questins yu may have by calling tll-free Enrllment Infrmatin Flexible Benefits Plan 8

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