How to use your Flexible Spending Account-Health Care (FSA-Health Care) and Flexible Spending Account-Dependent Care (FSA-Dependent Care) Accounts Overview of the Flexible Spending Account-Health Care (FSA-Health Care) & Flexible Spending Account-Dependent Care (FSA-Dependent Care) You have already selected the annual amount of money you wanted to contribute to your FSA-Health Care and/or your FSA-Dependent Care accounts for the calendar year during open enrollment. These dollars will be contributed to your FSA-Health Care and/or your FSA-Dependent Care accounts on a pretax basis each payroll and will assist you in paying for your eligible health care and dependent care expenses. You may file claims for eligible expenses up to the total annual election on or after January 1 each year. The full amount of your FSA-Health Care election is available to you for qualified health care expense reimbursements on January 1, each year. However, reimbursements for dependent care expenses will be made based on the amount in your FSA-Dependent Care account at the time of submission. In this case, if you receive partial reimbursement, the remainder of the reimbursement will be sent as funds increase in your account. Coventry Consumer Choice (C3) is our Plan Administrator for the FSA-Health Care and FSA-Dependent Care accounts, as well as the Health Reimbursement Arrangement (HRA). Please remember that Coventry Consumer Choice must receive all your claims for services incurred in 2012 by March 31, 2013 or you will forfeit any remaining funds. Eligibility You and your eligible dependents are eligible to participate in the FSA if you are: A regular full-time employee scheduled to work up to 40 hours per week A regular part-time employee scheduled to work 32 to 39 hours per week A limited part-time employee scheduled to work 20 to 31 hours per week Flexible part-time and temporary employees are not eligible for the Coventry Benefits Program. Important information about domestic partners Due to IRS regulations, domestic partners and their children are not eligible to receive benefits from your FSA-Health Care or FSA-Dependent Care funds. 1
What to pay when you receive health care services Be sure to have your providers send claims to the address on your ID card first, so the network discounts can be applied. At the time of service, you should only pay your copayment, if applicable. Automatic claims crossover for FSA-Health Care (C3's Smart Payment) (except Mercy, Springfield) With Smart Payment, your health care claims will be electronically submitted by your Coventry Health Plan for your qualified expenses such as office visit copays, hospital copays, prescription copays, annual deductibles or coinsurance. This service saves time since you do not have to complete an HRA/FSA Claim form. You also have the ability to modify Smart Payment in the following ways to better meet your need by logging in to your HRA account through My Online Services. Spend: When your payment choice is in the Spend mode, the member-responsible eligible expenses (deductible, copay and coinsurance) aligned with the medical and pharmacy plan are automatically processed and available funds are paid to the member or provider as follows: Copays: Pay to member Deductible: Pay to provider Coinsurance: Pay to provider Pharmacy, dependent care and other manual claims will always pay to the member. Save Review: In the Save Review mode you have a choice to review your claims and actively release each claim to a provider or yourself. With this option, you can also decide not to pay a claim from your FSA or HRA. When your payment choice is in this mode, you will be expected to manage your claims individually. For example: Claim #1: Save don't pay Claim #2: Pay to provider Claim #3: Reimburse member Save: In Save mode, the only ways to access your funds are to submit manual claims. Note: lf you do not have medical coverage through a Coventry Health Care plan and participate in the FSA-Health Care and/or the FSA-Dependent Care, you'll need to submit your claims manually. Your claims will not automatically cross over. Your FSA-Health Care combined with your HRA If you have elected the HRA plan and a FSA-Health Care, your claims will be paid first from your FSA-Health Care account, and second from your HRA account. This is done since the IRS has restrictions on rollovers of unused FSA-Health Care funds at the end of the year. However, if you remain enrolled in the HRA plan the next calendar year, up to two times your current in network deductible can be rolled over. 2
Website We want you to have all the tools you need to take charge of your FSA-Health Care and FSA-Dependent Care, anytime, day or night. You can access information by logging on to My Online Services via the Member portal of your medical plan's web page. You'll use the member information from your medical plan ID card to access your FSA account information. Note: lf you do not have medical coverage through Coventry (or participate in the Bismarck, ND PPO or Mercy, Springfield HMO or HRA) and participate in the FSA- Health Care and/or the FSA-Dependent Care, you'll receive an FSA ID card that will contain all of your member information, which can be used to access My Online Services via the member portal of www.healthamerica.cvty.com. Find all of the following important information on-line: Obtain Direct Deposit and FSA/HRA Claim forms o These are also available on the Human Resource's Benefits page of Coventry today Look up drug coverage through the online formulary Track FSA-Health Care and FSA-Dependent Care fund balances Check claim status (including pharmacy claims) View current eligibility and benefit information Display and print an ID card or request a new one Request wellness reminders (via email) for checkups Access Coventry WellBeing tools Claims submission Below is a list of medical claims you do not need to file as well as those you should continue to file: AUTOMATIC SUBMISSION CLAIMS Medical services copays Medical deductibles & coinsurance Medco prescription copays YOU MUST FILE THESE CLAIMS Dental claims Vision products - glasses, contact lenses, frames All OTC drugs (i.e. Tylenol, Motrin etc.) OTC drugs will only be eligible for reimbursement if prescribed by a physician. Contact your Health Plan if you need more information on which claims to file and which are automatically filed on your behalf. Manual claims submission You may submit a manual claim for reimbursement. Please be sure to complete the FSA/HRA claim form and attach an itemized receipt for the services claimed. The claim may be mailed, or faxed to Coventry Consumer Choice at the address and fax number provided on the form. 3
Coventry generally processes FSA claims within 24 to 48 hours. However, when you add mail time, the entire claim process from claim submission to your receiving reimbursement can take eight to fourteen business days to complete. Note: lf you do not have medical coverage through a Coventry Health Care plan (or participate in the Bismarck, ND PPO or Mercy, Springfield HMO or HRA) and participate in the FSA-Health Care and/or the FSA-Dependent Care, you'll need to follow the manual submission process. Direct deposit option You may select direct deposit to have payments deposited into an account of your choice. If you use the direct deposit method for reimbursement, you will receive reimbursement more quickly. To select the direct deposit option, simply fill out the Direct Deposit form available at My Online Services via the Member portal of your medical plan's web page, My Online Services via the Member portal of www.healthamerica.cvty.com for employees who do not have medical coverage through a Coventry plan (or participate in the Bismarck, ND PPO or Mercy, Springfield HMO or HRA), or on the Human Resource's Benefits page of Coventry today, and send it back to Coventry Consumer Choice. Confidential customer services Our confidential customer service teams can be reached by calling the number on the back of your ID card. They will be able to help you: Find a doctor Check your claims status Understand your benefits Check your eligibility Get extra support if you have a chronic condition Start the precertification process If you do not have medical coverage through Coventry (or participate in the Bismarck, ND PPO or Mercy, Springfield HMO or HRA), please call 1-800-691-9984, for questions concerning your FSA-Health Care or FSA-Dependent Care accounts. Get the most from your health care dollars 1. Use in-network providers. You might have noticed that your deductible, coinsurance and out-of-pocket maximum are lower when you use in-network providers. If your doctor does not participate in the network, you can find a list of participating providers on the member website or by calling member services at the toll-free number printed on your ID card. 2. Know when to call before receiving covered services. This is important to avoid a possible denial of benefits. You can find this information in your summary plan description (SPD). 4
3. Try generic drugs. You can save on your prescription copays when you use generic drugs. These drugs are safe to use and just as effective as brand-name drugs. Be sure to ask your doctor if a generic substitution is available when he or she writes a prescription for you. 4. Bring the Coventry formulary to your doctor appointment. Show it to your doctor and ask to try the most cost-effective drugs first, the formulary is divided into tiers based on cost and efficacy. You can save by using drugs on a lower tier. A printable formulary is available on your health plan website. 5. Participate in special programs. You are eligible to participate in your plan's wellness or disease management programs. They can help you manage your health better so you can avoid extra health expenses in the future. Flexible spending accounts are also a good way to set aside funds before taxes for covered eligible health care and/or dependent care expenses. 6. Carry your ID card with you. This helps providers identify you as a member entitled to benefits. It also gives the claims address and important numbers for providers to call. Coventry WellBeing With Coventry WellBeing, you can select better benefits for better health and improve your diet, fitness level, emotional well-being, and more. Plus, Coventry WellBeing can help you identify risk factors you may have for certain health conditions. The WellBeing program provides you with knowledge and tools to build a healthier lifestyle. Features of the program include: Receive up to $150 per year per member for reimbursement toward the cost of approved weight management classes and programs. Take a health risk assessment and receive a personalized plan to help you improve your health and have access to nine digital coaching programs. o Balance Weight Management o Breathe - Smoking Cessation o Relax Stress Management o Nourish Nutrition Improvement o Move Physical Activity o Achieve Cholesterol Management o Control Blood Pressure Management o Overcoming Depression Depression Management o Overcoming Insomnia Sleep Improvement Plus, the program helps you track your progress with many tools, such as a step tracker, a restaurant guide for healthy choices, BMI calculator, cookbook and a portion size tool. Next steps In order to maximize your FSA-Health Care, we recommend you do the following: 5
Website Go to My Online Services as outlined above to obtain forms, check your account balance, modify your Smart Payment options or obtain information on your account anytime. Direct Deposit - Complete the HRA/FSA Direct Deposit Form and return it to Coventry Consumer Choice. 2011 Claims Make sure you submit your 2011 claims by March 30, 2012 to ensure that you don't lose any unused funds. Frequently Asked Questions What is the maximum amount of money I can contribute in each benefit plan year? You can contribute up to $5,000 to your FSA-Health Care and up to $5,000 to your FSA- Dependent Care accounts. What if I want to change my election mid-year? You choose your FSA contribution amount during open enrollment when you elect/change your benefits such as medical, dental, etc. Once your contribution election becomes effective, you won't be able to change it until the next open enrollment period, unless there is a change in your eligibility status (such as marital status, a newborn, an adoption, etc.). Will I get paid less every pay period if I enroll in an FSA? Your gross, or pretax, pay will remain the same. But your 'net' pay will be lower because a portion of it will go into your FSA account. The advantage is that this money gets put into your FSA account before taxes, which lowers your 'taxable' income. So you get the double advantage of saving money for health care expenses and paying fewer taxes. Do I earn interest on the money I contribute to my FSA? No. FSAs are not required to accrue interest. The same is true for Health Reimbursement Arrangements (HRAs). When can I start using my FSA? You have the ability to use your full annual amount of FSA-Health Care dollars on day one, even though your contributions will be made each pay period during the year. FSA- Dependent Care expenses will be reimbursed based on the amount in your FSA- Dependent Care account at the time of submission of your reimbursement request. What if I submit more expenses during the benefit plan year than I have contributed to date? You can access your entire year's worth of contributions to your FSA-Health Care on January 1 st, for health care expenses. For example, you could get your child's braces in January and be reimbursed for the entire out-of-pocket amount right away before the year's entire payroll deductions have been made. However, for your FSA-Dependent Care account, you must have sufficient funds in your Dependent Care account to receive reimbursement. You will receive payment based on the amount in your account at the time of submission. In this case, if you receive partial reimbursement, C3 will send the remainder of the reimbursement amount as funds increase in your account. 6
How do I request a reimbursement? If you're enrolled in a Coventry Health Care EPO, HMO or HRA plan (except Mercy, Springfield), the Smart Payment feature allows the correct party to receive reimbursement for some health care expenses automatically, whether it is you or the provider. Smart Payment can be customized by you to better meet your needs simply by going to My Online Services through the website on the back of your medical plan or stand alone FSA-Health Care ID card. For some expenses, such as claims from a medical plan outside of Coventry Health Care (Bismarck, ND PPO or Mercy Springfield HMO or HRA), Dental, Vision, or dependent care services, you will have to submit a claim. Submitting the proper documentation will help ensure that your claim processing is not delayed. The documentation submitted with a claim should include the following: Itemized receipt, itemized bill or invoice Complete FSA/HRA reimbursement form. You can find one at the website printed on the back of your ID card. Send your claims in the following ways: Mail both the receipt( s) and the form(s) to the address printed on the form. Fax the receipt(s) and form(s) to the fax number on the form. How often can I submit reimbursement requests? You can submit reimbursement requests at any time. Can health care and dependent care providers be paid directly? C3 will pay your health care providers directly for your share of your deductible and coinsurance if you are enrolled in a Coventry Health Care EPO, HMO or HRA plan (except Springfield, Mercy). However, the reimbursement from your FSA-Dependent Care account for dependent care expenses will be sent to you. The Smart Payment feature reimburses the correct party for eligible health care expenses, whether it is the provider or the member. C3 can make payment via direct deposit or by check and you can customize the Smart Payment feature to change how payments are directed by visiting My Online Services. How do I set up direct deposit of my reimbursements? You must complete a form and submit it to Coventry Consumer Choice for direct deposit. You can find this form at the website printed on the back of your ID card. You can also request a form by calling the member services number printed on the back of your ID card. How will I know the balance of funds in my FSA? You can find balance information by visiting the website or calling the member services number printed on the back of your ID card. Are all over-the-counter (OTC) products eligible for reimbursement from my FSA? No.OTC medicines and products used for medical purposes (not for cosmetic purposes or general health) will only be eligible for reimbursement if prescribed by a physician. Eligible OTC items include medicines or products that alleviate or treat illness for you and your dependents (like Tylenol, Pepcid, Motrin IB, Lactaid, St. Joseph 7
Aspirin, Imodium, etc.). Nutritional supplements (such as vitamins, herbal supplements and natural medicines) are not eligible unless you have been directed to use them by a licensed practitioner to treat a specific medical condition and the item is not consumed to maintain general health. A written directive from the practitioner is required for reimbursement. What is an eligible health care expense? Generally, eligible health care expenses are expenses tied to medical care. Eligible medical expenses may be for you, your spouse, children, and any other person who is a qualified dependent under the Internal Revenue Code. You can order IRS Publication 502, which lists eligible expenses, by calling 1-800-TAX-FORM. 8