1
YOUR FLEXIBLE SPENDING
Health Care Flexible Spending Accounts allow you to save money from your paycheck on a pre-tax basis to cover
certain medical, dental, vision and over-the-counter expenses not otherwise covered by your health insurance.
Please note:
The maximum amount that you can set aside for 2013 is $2,500.
Health Care Reimbursement Accounts
Whose expenses can be reimbursed?
3 You can be reimbursed for expenses:
• incurred by you • your spouse
• your children up to or through the age of 26 (dependent upon your FSA Plan of Benefits)
You can be reimbursed for any health, dental, vision and certain over-the-counter (OTC) expenses that are medically necessary but are not covered by your insurance such as:
• Deductibles
• Co-payments for medical and prescriptions • Dental expenses
• Hearing expenses • Vision expenses
• Certain over-the-counter products
Allowable Over-the-Counter Expenses
The list of OTC items that are eligible without a prescription include, but are not limited to
insulin, band aids, braces, contact lens solution, elastic bandages & wraps, first aid supplies and reading glasses.
Over-the-Counter Expenses
Requiring a Prescription
Items requiring a prescription include, but are not limited to, acne medicine, allergy medicine, cough, cold and flu medicine, eye drops, nasal sprays/drops, ointment for cuts/burns/rashes, and pain relievers. Health Care debit cards can be used to purchase items requiring a
prescription as long as the prescription is presented to the pharmacist, mail order or web-based vendor that dispenses the medicine.
Paper Claims require:
• a copy of the prescription • an itemized receipt
USE IT OR LOSE IT!
IRS Ruling:
• Because the dollars in your FSA are not taxed, you must use all of the funds you set aside for that Plan year.
• Estimate your needs carefully.
Any FSA dollars not used within the plan year will be lost.
Election/Status Change
Election Changes:
During the year you may not adjust your election amount without a “Status Change”
What is a “Status Change”?
•Change in marital status
Marriage or divorce
•New family member
Birth, adoption
•Spouse’s job change
Loss of employment, re-employment
Dependent Care
Reimbursement Accounts
Dependent Care Account
A Dependent Care Flexible Spending Account allows you to save money from your paycheck on a pre-tax basis to cover certain costs
Who is covered?
You may be reimbursed for expenses
incurred for any child under the age of 13 or any other eligible dependents
(including, but not limited to, a parent, spouse or step-child) physically or
mentally unable to care for themselves,
in accordance with IRS regulations.
You can be reimbursed for expenses for which the primary purpose is to assure your dependent’s well being and
safety such as:
• Dependent Care in someone else’s home • Dependent Care in your home
• Dependent Care in a child or adult day care center • Nursery school expenses
• After school programs • Summer day camp
The maximum per household is $5,000.
Please note: Reimbursement for dependent care
expenses cannot exceed dollars contributed to your account.
What is the maximum amount that I can elect
for a dependent care account?
Claim forms can be mailed, or faxed or
sent electronically through EBPA’s Secure Document Submission Portal at https://secure.ebpabenefits.com
EBPA Benefits Card
Q&A
The first time you use your card, it will be automatically activated.
How do I activate my
Do I choose debit or credit at the card
terminal when I use my card?
By April of 2013, pin technology will be combined with the existing signature network currently in use. Congress passed the Durbin Amendment which requires that
almost all debit and prepaid cards have two or more unaffiliated networks associated with the card.
Merchants can choose debit or credit.
We will notify you when you need to set up a pin number for the card.
Card reissue will not be necessary.
17
At this time, you should choose credit.
Can I request additional cards
for my spouse and dependents?
Yes, additional cards can be requested for
No, you do not have to use the Benefits card. The Benefits Card is provided as a convenience.
If you choose not to use the Benefits Card (or forget to use the Benefits Card), you may send in a paper claim form with the proper documentation for
reimbursement.
Do I have to use the Benefits Card?
No. The Benefits Card is valid for three years from date of issue as long as you remain part of your employer’s benefit plan and elect FSA each year. The Benefits Card will be loaded with your new annual election at the beginning of each plan year for Health Care. Dependent Care funds will be
added to the card as they are deducted from your
paycheck and received by EBPA
Do I need a new
When you use the EBPA Benefits Card, you no longer need to pay out-of-pocket and wait for a reimbursement.
However, claims may need to be substantiated, therefore, all receipts should be retained.
Please note: Letters/emails will be sent requesting Substantiation when required.
What is the advantage of using the
EBPA Benefits Card?
Can the Benefits Card be used for medical,
dental, hospital, and vision expenses?
Yes, the Benefits Card can be used for these expenses.
If the transaction amount does not match your
employer's benefit plan co-payments, the system will allow the transaction and you will not have to pay
out-of-pocket, but a letter will be sent to you requesting an itemized receipt.
Reminder: All medical, dental, hospital and vision claims must be submitted to your insurance carrier first for
Can the Benefits Card be used for
eligible over-the-counter expenses?
Yes, the Benefits Card can be used for eligible over-the-counter
expenses.
Insulin and other over-the-counter items such as band-aids are auto-substantiated at vendors through a process called the
“Inventory Information Approval System” (IIAS).
Can the Benefits Card be used for
over-the-counter drugs and medicines?
Over-the-counter (OTC) drugs and medicines such as
Tylenol, aspirin, etc., must be accompanied by a physician’s prescription in order to be reimbursed under an FSA.
The EBPA Benefits Card can be used for prescribed OTC
drugs and medicines as long as the prescription is presented to the pharmacist, or the mail order, or web-based vendor that dispenses the medicine.
If I use my card for a Prescription
will I be asked for a receipt?
You will not be asked for a receipt if the pharmacy has the Inventory Information Approval System (IIAS).
The IIAS system will automatically approve all prescriptions and you will not be asked for a receipt.
Will I be asked to substantiate
any card transactions?
Yes, there are occasions when you will be asked to substantiate your card transaction.
What happens if I do not substantiate a
Health Care transaction and
I have a Transit Account?
If you do not substantiate a Health Care transaction within the time period requested, the card will not be able to be used for any account including Transit,
Parking and Dependent Care.
If I use my card for doctor’s visits
will I be asked to submit a receipt?
You will not be asked for a receipt if the transaction amount matches your employer‘s benefit plan office
visit co-payment. If the transaction amount is a
different amount such as the co-payment for a
spouse’s plan that does not match your employer‘s co-payment, the system will allow the transaction and you will not have to pay out-of-pocket.
The transaction will be denied.
You will need to pay for the product or service and submit the itemized bill/receipt, along with a claim form.
What happens if there is not enough money in my
account to pay the full cost of the service?
If the Orthodontic service is billed for the year, you may use the Benefits Card, but you will be asked to
substantiate the transaction.
If you are on a monthly payment plan, once the card is used for the first payment, a letter will be sent requiring substantiation. When sending substantiation please
indicate it is a recurring transaction by noting “Recurring Expense” on the Substantiation Request Letter. After we receive this information, we can program the system to automatically approve the monthly transaction.
What are the options for submitting orthodontic
Yes, your online account displays paper claim transactions as “MANUAL” and Benefits Card transactions as “CARD.”
Does my online FSA account information
display both paper claim submissions
and Benefits Card claims?
Yes, the Benefits Card can be used for Dependent Care expenses if the provider accepts credit cards and
adequate funds are currently in the dependent care account.
Can the Benefits Card be used for
The Benefits Card is deactivated the date of termination.
If I terminate, when will the Benefits Card be
deactivated? Can claims still be submitted
for eligible expenses prior to termination?
Paper claims can be submitted for eligible expenses incurred prior to the termination date.
You should contact EBPA’s FSA Customer Service Department at 1-888-678-3457.
