FLEXIBLE SPENDING ACCOUNTS BANKING INFORMATION PACKAGES

Transcription

1 FLEXIBLE SPENDING ACCOUNTS BANKING INFORMATION PACKAGES The following pages describe the Bank set-up options available for the reimbursement of Flexible Spending Account expenses. Option 1: Policyholder opens own bank account. BCBSGA signature appears on checks Option 2: Policyholder opens own bank account. Policyholder signature(s) appear on checks. Option 3: BCBSGA sets-up/reconciles bank account. Policyholder funds account.

2 OPTION #1 BANKING INFORMATION PACKAGE FOR YOUR FLEXIBLE SPENDING ACCOUNT Policyholder opens own bank account. BCBSGA signature appears on checks. The Bank Account should be a separate account set up by the policyholder, under the policyholder s name, specifically for FSA deposits/contributions from the employee payroll. The account is maintained and reconciled by the policyholder. BCBSGA has a Checkwriter system which will write checks drawn from this bank account to reimburse participants for their eligible Flexible Spending Account expenses. To set-up the Checkwriter system, the policyholder must provide the following information: 1. The Bank Account Information Worksheet (attached) should be completed by the policyholder and returned to BCBSGA s Flexible Benefits Department. 2. The Authorization Letter (sample attached) should be produced on the policyholder s letterhead and signed by the policyholder. This authorization letter should be returned to BCBSGA s Flexible Benefits Department, 233 S. Wacker Dr., Suite 3900, Chicago, IL with the signature card(s) in #3 below. Please do not forward this information directly to the Woodland Hills address. 3. Signature Card(s). The policyholder should obtain signature card(s) from their bank with all necessary account information completed by the policyholder and/or their bank. (The number of signature cards required is determined by the bank.) The signature cards should then be sent to BCBSGA for signature along with the Authorization Letter in #2 above. This will give BCBSGA authority to write checks drawn from this account to reimburse FSA participants. The policyholder will also sign the bank signature card(s). Note: The authorized BCBSGA signature will be that of David C. Colby, Chairman & CEO. BCBSGA will not be able to provide the Driver s License number or the Social Security number of David C. Colby. Tax ID # should be used for reference on the signature card(s). 4. MICR Specifications (MICR Specs). The policyholder should obtain the MICR Specs from their bank. These specifications provide BCBSGA with the proper placement on the checks of the routing number, account number, etc. Once the MICR Specs have been received by BCBSGA and set up on the Checkwriter System, a set of sample checks will be produced and mailed to the bank for approval. Bank approval of the sample checks is required before BCBSGA can begin issuing checks to FSA participants. PLEASE NOTE: The banking information is a critical step in the set-up of a Flexible Spending Account. All of the above four steps must be completed before BCBSGA can begin issuing Flexible Spending Account reimbursement checks. 1-1

3 FLEXIBLE SPENDING ACCOUNT BANK ACCOUNT INFORMATION WORKSHEET POLICYHOLDER INFORMATION NAME OF COMPANY BUSINESS ADDRESS BUSINESS TELEPHONE CHECKING ACCOUNT TITLE TAX I.D. NUMBER BANK INFORMATION NAME OF BANK BANK ADDRESS ROUTING AND TRANSIT NUMBERS ACCOUNT NUMBER CONTACT AT BANK NAME TITLE DEPARTMENT TELEPHONE NUMBER Completed by: Date: 1-2

4 The sample Authorization Letter below, should be prepared on the Policyholder s letterhead and signed by the appropriate individual. The letter, along with the bank signature card(s), should then be sent to: BCBSGA Flexible Benefits Department 233 S. Wacker Dr. Suite 3900 Chicago, IL Please, DO NOT send directly to Rashida Christion at the address in the letter. Sample Authorization Letter (On Corporate Letterhead) [DATE] Ms. Rashida Christian, Manager Accounting Alternate Funding Group Finance Mail Stop AC10E Dear Ms. Christian: This is to authorize BCBSGA to use the facsimile signature of David Colby on our Flexible Spending Account # [BANK ACCOUNT #] effective [EFFECTIVE DATE]. Very Truly Yours, [SIGNER S NAME] [SIGNER S TITLE]

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6 OPTION #2 BANKING INFORMATION PACKAGE FOR YOUR FLEXIBLE SPENDING ACCOUNT Policyholder opens own bank account. Policyholder signature(s) appear on checks. The Bank Account should be a separate account set up by the policyholder, under the policyholder s name, specifically for FSA deposits/contributions from the employee payroll. The account is maintained and reconciled by the policyholder. BCBSGA has a Checkwriter system which will write checks drawn from this bank account to reimburse participants for their eligible Flexible Spending Account expenses. To set-up the Checkwriter system, the policyholder must provide the following information: 1. The Bank Account Information Worksheet (attached) should be completed by the policyholder and returned to BCBSGA s Flexible Benefits Department. 2. Sample Signature(s). The policyholder should provide samples of the signature(s) they wish to appear on the checks. Samples should be in black ink on plain white sheet of paper. (If possible, please provide 2 samples of each signature.) The maximum number of signatures that can be placed on the checks is two. 3. MICR Specifications (MICR Specs). The policyholder should obtain the MICR Specs from their bank. These specifications provide BCBSGA with the proper placement on the checks of the routing number, account number, etc. Once the MICR Specs have been received by BCBSGA and set up on the Checkwriter System, a set of sample checks will be produced and mailed to the bank for approval. Bank approval of the sample checks is required before BCBSGA can begin issuing checks to FSA participants. PLEASE NOTE: The banking information is a critical step in the set-up of a Flexible Spending Account. All of the above three steps must be completed before BCBSGA can begin issuing Flexible Spending Account reimbursement checks. 2-1

7 FLEXIBLE SPENDING ACCOUNT BANK ACCOUNT INFORMATION WORKSHEET POLICYHOLDER INFORMATION NAME OF COMPANY BUSINESS ADDRESS BUSINESS TELEPHONE CHECKING ACCOUNT TITLE TAX I.D. NUMBER BANK INFORMATION NAME OF BANK BANK ADDRESS ROUTING AND TRANSIT NUMBERS ACCOUNT NUMBER CONTACT AT BANK NAME TITLE DEPARTMENT TELEPHONE NUMBER Completed by: Date: 2-2

8 OPTION #3 BANKING INFORMATION PACKAGE FOR YOUR FLEXIBLE SPENDING ACCOUNT BCBSGA sets-up/reconciles bank account. Policyholder funds account. The Bank Account will be set up by BCBSGA through an arrangement with JP Morgan Chase Bank. The account is reconciled by BCBSGA and funded by the Policyholder. A Checkwriter system will write checks drawn from this bank account to reimburse participants for their eligible Flexible Spending Account expenses. To set-up the Bank Account and Checkwriter system, the policyholder must provide the following information: 1. Customer Information Worksheet (attached) should be completed by the policyholder and returned to the Flexible Benefits Department. 2. Customer Authorization for Pre-authorized Debits (sample attached). If, on the Customer Information Worksheet, the policyholder selects the AHC (initiated by Chase) funding arrangement, then this letter must also be returned to the Flexible Benefits Department along with the Customer Information Worksheet. PLEASE NOTE: The banking information is a critical step in the set-up of a Flexible Spending Account. All of the above steps must be completed before BCBSGA can begin issuing Flexible Spending Account reimbursement checks. 3-1

9 CATALYST CUSTOMER INFORMATION WORKSHEET COMPANY INFORMATION Name of Company Business Address Business Tele. Checking Acct. Title Tax I.D. Number Line of Business Bank Information* * only necessary for AHC transfers Local Bank Name Local Bank Address Account Number At Local Bank Type of Account At Local Bank DDA (Checking Acct) Funding Arrangement : Wire (initiated by planholder) AHC (initiated by Chase) Notification: phone fax Contact Name: Phone Number: Address: Fax Number: 3-2

10 CUSTOMER AUTHORIZATION FOR PREAUTHORIZED DEBITS TO LOCAL ACCOUNT FOR FSA ACCOUNT Date: Name and Address of Local Bank: Name and Address of Policyholder: Re: Account # Transit ABA Routing # Dear Sirs: With regard to our above referenced DDA account with (bank name) (the Depository ) entitled, (the Account ) we hereby authorize BCBSGA Insurance Company (the Company ) of Springfield, Massachusetts and/or JP Morgan Chase Bank to initiate debits to the account (which debits, herein referred to as Debit may be in the form of Electronic Funds Transfer or other paper instruments) and we hereby authorize and direct the Depository to Debit the Account in the amount of each Debit and to honor and pay the same in accordance with its terms and we hereby authorize. The Authorization and direction set forth in this letter shall be a standing authorization and direction and shall remain in full force and effect until the Company and the Depository receive written notice of termination in such a manner as to afford the Company and the Depository a reasonable opportunity to act on it. No further or other authorization shall be required as a condition to the honoring and payment by the Depository of any individual Debit as contemplated by the foregoing. Sincerely, Policyholder Name (Authorized Signature) (Title) 3-3