FSA Debit Card Guide
IMPORTANT: Please Read
There are many misconceptions about debit cards and FSAs.
Before you read any further, it’s important to understand that
using the FSA debit card does NOT eliminate the need to file
paperwork with Flexible Benefit Service Corporation (FLEX).
To learn more about the requirements for your debit card claims,
go directly to Section 3, page 4.
The FlexMoney Card® is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc.
Section 1: Understanding Your FSA Debit Card
1.
What is the FlexMoney Card?
Your FlexMoney Card® is a Visa® debit card that gives you easy access to the funds in your
Health Care Flexible Spending Account (FSA), and a convenient way to pay for eligible health
care expenses. Using the debit card eliminates the need for you to pay out-of-pocket and wait
for reimbursement.
2.
When will I receive my debit card?
Once the debit card is ordered, it will be delivered to your mailing address on file within 7 to 10
business days.
3.
Can I have multiple debit cards?
You will automatically receive one debit card when you enroll in the Health Care FSA.
If you need additional debit cards for your spouse or dependents, you can order extras online
through www.flexiblebenefit.com. You can receive up to four total debit cards per family, and
there is no charge for the additional debit cards.
4.
How do I activate my debit card?
Once you receive your debit card in the mail, you’ll need to activate it by calling 800-963-2071.
The number and instructions for activation will be on the front of the debit card.
5.
What if my debit card is lost or stolen?
If your debit card is lost or stolen, please contact our Customer Service Team at 866-472-5351
immediately. A replacement debit card will be sent within 14 days. You can also logon to
flexiblebenefit.com to report your debit card as lost or stolen.
PG.1
The FlexMoney Card® is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc.
Learn more at f lexiblebenef it.com
866-472-5351
6.
Is there a daily transaction limit?
There is a daily debit card transaction limit of $7,500 or 10 transactions, whichever comes first.
7.
Can I manage my account online?
Yes, you can create an online account at www.flexiblebenefit.com that will allow you to check your
balance and account details, view debit card transactions, access forms and educational materials,
and more.
8.
Who do I contact with questions?
For any questions regarding your debit card or your account information, please contact our
Customer Service Team at 866-472-5351 or [email protected].
Section 2: Using Your FSA Debit Card
1.
How does the debit card work?
Present the debit card as payment for eligible goods and services. Qualified purchases will be paid
directly from your Health Care FSA. The FlexMoney Card works like any other debit card, except for
a few important differences:
●
●
It is limited to specific merchants and eligible expenses, which are determined by the
benefit you selected.
Your debit card transactions can be done as debit with the PIN provided, or as credit with
no PIN required.
●
The debit card cannot be used at an ATM or for cash back when making a purchase.
2.
Where can I use my debit card?
You can use your debit card at qualified locations including hospitals, physician and dental offices,
pharmacies and merchants with IIAS certification.
PG.2
The FlexMoney Card® is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc.
Learn more at f lexiblebenef it.com
866-472-5351
3.
What is IIAS?
IIAS is an Inventory Information Approval System as specified by the IRS. This system allows
retailers to automatically substantiate eligible Health Care FSA purchases through their inventory
control system (UPS or SKU number.)
For example, if you purchase contact lens solution, which is an eligible expense, the UPC code will
recognize that item as eligible and will allow the charge on your debit card.
4.
What if I buy multiple items and not all are eligible?
If a retailer has the IIAS system, only the eligible items will be processed on your debit card.
You will need to purchase any other, non-eligible items with another form of payment.
5.
How can I find an IIAS merchant?
Retailers such as Walgreens®, CVS®, Walmart® and many more have implemented the IIAS system.
For a complete list of vendors, you can check online at www.sig-is.org.
6.
What expenses are eligible?
Depending on your employer’s benefit plan, it can include anything from hospital stays and doctor
or dentist visits to prescription drugs and eye glasses. For a detailed listing of eligible expenses,
visit the Resources section of www.flexiblebenefit.com.
7.
What if there is not enough money in the account to cover the entire purchase?
The transaction will be denied, and you will need use another form of payment. You can file a
request for reimbursement with Flex, and we will review your account and reimburse you with
any remaining funds. Alternatively, you can ask the merchant to charge the debit card for the
remaining balance and use another form of payment for the additional cost.
8.
What if a doctor or merchant does not accept the debit card?
You will need to use another form of payment and submit a request for reimbursement.
PG.3
Learn more at f lexiblebenef it.com
866-472-5351
Section 3: Substantiating Your FSA Debit Card Claims
1.
What is substantiation?
Before we get into the details of what substantiation means with your debit card, let’s simplify the
meaning of the word. The actual definition of substantiate is to validate, verify, prove, confirm or
authenticate.
Your FlexMoney Card and Health Care FSA are regulated by the IRS, and their rules require that all
of your debit card transactions must be substantiated. This means, purchases made with the debit
card must be proven to be eligible under the plan.
Some of your transactions—such as known co-pays and IIAS transactions—will automatically
substantiate with no additional information required. All other transactions will require
documentation in order to substantiate the claim as an eligible expense.
2.
I used my debit card at my doctor or dentist’s office, why do I need to substantiate?
Even though a doctor or dental office is an eligible location, not all services provided are eligible
under the plan. IRS regulations require that Flex verify the eligibility of all expenses charged to
the debit card.
3.
What information is required for substantiation?
In order to substantiate your transaction, you must provide Flex with a third party statement
which includes the following information:
●
The name of the person for whom the service was provided
●
The date that service was provided
●
The total amount of the expense
●
The name of the provider
●
The type of service provided
PG.4
The FlexMoney Card® is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc.
Learn more at f lexiblebenef it.com
866-472-5351
The following examples illustrate acceptable and unacceptable
statements and information for debit card substantiation:
Both of these are Acceptable Documentation, because they include the provider’s name, the patient’s name,
the date of service, a description of the service being billed and the amount charged.
NG FOR PAYMENT
CHECK CARD USING FOR PAYMENT
ABC Dental
Make Checks Payable to
Chicago Medical Group
PO BOX325
202Greenway Drive
Chicago,
IL 60012
Suite
#652
EXPIRATION DATE
ABC Medical
PAY THIS AMOUNT
4
PATIENT ACCT#
555 Anystreet 123584
$65.00
Chicago, IL 60010
773-945-4569 SHOW AMOUNT
DATE
Email: EXPIRATION
[email protected]
STATEMENT DATE
STORE:
REGISTER:001
CASHIER: 764b
ASSOCIATE: 0012E
-----------------------------
Statement #:
Date:
John Doe
Customer ID:
324 Main St.
Chicago, IL 60011
Chicago Medical Group
PO BOXRECEIPT
202
CUSTOMER
Chicago, IL 60012
Date
DATE OF
SERVICE
BALANCE
CODE
Type
00
Description
DESCRIPTION OF SERVICE
54556874133
CHARGES
Amount
Balance Forward
10/10/14
XXXX4
OFFICE VISIT, 25 MIN
$200.00
$140.00
10/10/14
XXXX5
BLOOD DRAW
$20.00
Payment
RSM
HealthCare
[email protected]
Explanation of Benefits (EOB) THIS IS NOT A BILL
12-12-14
STATEMENT
Anthony#:Doe22587941
Statement
100 Ohio ave.December 21, 2014
Date:
Chicago,
Customer
ID:IL 60601
254789
INSURANCE
PAYMENTS
Date
Balance
BALANCE
125.00
Type
Bill To: Dr. Dale Jones
ABC Dental
325 Greenway Drive
Suite #652
Claim
Information
Chicago,
IL 60164
Member Name:
Group No:
Identification No:
Description
Amount
Claim No:
Payment
Patient Name:
Summary
12/10/14
Total Billed
125.00
$140.00
$60.00
Customer Service: 1-800-854-8894
Invoice #
54556874133 $45.00
Balance Forward
Total Benefits Approved
Amount you may owe provider
---------------------------------------------------------
SUBTOTAL
259.00
SALES TAX
21.45
TOTAL
281.44
0
---------------------------------------------------------
Email:
Suite #652
Chicago, IL 60164
123584
Bill To: Dr. Dale Jones
ABC Dental
Chicago Medical Group
325 Greenway Drive
PO BOX 202
Suite #652
Chicago, IL 60012
Chicago, IL 60164
Invoice #
Phone: (773) 436-0001
Fax:
(773) 436-0002
SHOW AMOUNT
PAID HERE
22587941
December 21, 2014
254789
12/10/14
259.00
$65.00
SIGNATURE
ORIGINAL TRANSACTION INFO
PAYMENTS
PATIENT ACCT#
FOR BILLING INQUIRIES: 773-302-9874
STATEMENT
-----------------------------
STORE: 0032
REGISTER: 001
DATE: INSURANCE
12/31/2014
GES
NUMBER: 5194
PAY THIS AMOUNT
10/18/14
Chicago, IL 60164
PAID HERE
ABC Dental
RSM
HealthCare
325 Greenway Drive
Phone: (773) 436-0001
Fax:
(773) 436-0002
CARD NUMBER
Anthony Doe
100 Ohio ave.
Chicago, IL 60601
Anthony Doe
987654321
CDE32165498
Balance
202000000235X
Anthony Doe
125.00
Summary
125.00
Total Billed
Total Benefits Approved
Amount you may owe provider
$16.20
$1.80
$60.00
The following shows how this claim was adjusted
The following shows how this claim was adjusted
Service Information
Service Information
AMOUNT TENDERED
VISA
281.44
$15.00
$5.00
ACCT:*******1245
EXP:*****
APPROVAL:9999
CARDHOLDER: JANE SMITH
TOTAL PAYMENT
281.44
$45.00
$16.20
$1.80
$15.00
$5.00
Service Description
Not
Covered
Amount
Billed
Service Date
Covered
Service Description
Service Da
IMAGING RADIOLOGISTICS LLC
IMAGING RADIOLOGISTICS LLC
11/09/14
MEDICAL EMERG X-RAY
45.00
27.00 (1)
18.00
MEDICAL EMERG X-RAY
45.00
27.00
18.00
Totals
45.00
27.00
11/09/14
-----------------------------
TRANSACTION: 1/8/2005 2:40 PM
Totals
CARDHOLDER SIGNATURE:
Coverage Information
Coverage Information
_______________________________
$125.00
Total
Totals
Reminder: Please include the statement number on your check.
PARTICIPATING PROVIDER OPTION (PPO REDUCTION)
Terms:
Balance due in 30 DAYS.
Reminder: Please include the statement number on your check.
Terms: Balance due in 30 DAYS.
Statement #:
Date:
DAYS
AMOUNT
DUE:
$65.00
CURRENT
Customer
Jon G. Castro
TotalName:
Deductions
$65.00
12/21/14
30-60 DAYS
Amount Due:
60-90 DAYS
90-120 DAYS
$125.00
AMOUNT
DUE:
Chicago Medical Group
PO BOX 202
Chicago, IL 60012
EXPIRATION DATE
CARD NUMBER
ABC Medical
STATEMENT DATE
PAY THIS AMOUNT
PATIENT ACCT#
$65.00
123584
555 Anystreet
Chicago, IL 60010
SHOW AMOUNT
PAID HERE
773-945-4569
10/18/14
SIGNATURE
FOR BILLING INQUIRIES: 773-302-9874
-----------------------------
-----
O
DATE OF
SERVICE
00
10/10/14
---------
00
5
44
---------
STORE:
REGISTER:001
CASHIER:
Chicago764b
Medical Group
ASSOCIATE: 0012E
PO BOX 202
-----------------------------
John Doe
324 Main St.
Chicago, IL 60011
10/10/14
Unacceptable
Documentation
CODE
DESCRIPTION OF SERVICE
DoesOFFICE
not VISIT,
include
XXXX4
25 MIN
description of item
or service being
XXXX5
BLOOD
DRAW
billed.
Chicago, IL 60012
CUSTOMER RECEIPT
ORIGINAL
TRANSACTION
INFO
CHARGES
INSURANCE
BALANCE
PAYMENTS
STORE: 0032
REGISTER: 001
NUMBER: 5194
$140.00
$20.00
$60.00
259.00
$16.20
Total Benefits Approved
May Owe Provider
Date: Amount You12/21/14
$1.80
Amount You May Owe Provider
Does not include the
date of service, only
the payment date.
44
----PM
____
$15.00
Phone: (773) 436-0001
Fax:
(773) 436-0002
Email:
CARD NUMBER
PO
BOX 202
325
Greenway
Drive
Suite
#652 IL 60012
Chicago,
Chicago, IL 60164
[email protected]
STATEMENT DATE
PAY THIS AMOUNT
FOR BILLING
STATEMENT
Statement #:
Date:
Customer ID:
TRANSACTION: 1/8/2005 2:40 PM
CARDHOLDER SIGNATURE:
John Doe
324 Main St.
Chicago, IL 60011
Date
Type
Invoice #
$65.00
30-60 DAYS
60-90 DAYS
90-120 DAYS
90-120 DAYS
AMOUNT
DUE:
Amount
Payment
Group
PO BOX 202
Chicago, IL 60012
Balance
325 Greenway Drive
Suite #652
Chicago, IL 60164
Explan
12-12-1
STATEMENT
Custom
Statement #:
Date:
Customer ID:
22587941
Decembe
254789
Unacceptable
Documentation
Membe
Group
Identif
Claim N
Patient
Summary
DATE OF
SERVICE
10/10/14
54556874133
Balance Forward
125.00
CODE
DESCRIPTION OF SERVICE
XXXX4
OFFICE VISIT, 25 MIN
125.00
CHARGES
INSURANCE
PAYMENTS
$200.00
$140.00
10/10/14
XXXX5
BLOOD DRAW
$20.00
$15.00
$45.00
Does not include $16.20
Date
$1.80
original date of
12/10/14
service.
The following shows how this claim was adjusted
Total Billed
Total Benefits Approved
BALANCE
Amount you may owe provider
Does not include
description ofService Date
IMAGING
RADIOLOGISTICS
LLC
item
or service
11/09/14
MEDICAL EMERG X-RAY
being billed.
Type
Service Information
$60.00
Service Description
$5.00
Amount
Billed
N
C
45.00
2
45.00
Totals
Coverage Information
Total
$125.00
Reminder: Please include the statement number on your check.
Terms: Balance due in 30 DAYS.
45.00
Totals
-
PARTICIPATING PROVIDER OPTION (PPO REDUCTION)
Deductions
Your 10% Coinsurance Amount..............
Customer Name: Jon G. Castro
$65.00
Anthony Doe
100 Ohio ave.
Chicago, IL 60601
Bill To: Dr. Dale Jones
ABC Dental
325 Greenway Drive
Suite #652
Chicago Medical
Chicago, IL 60164
Description
ABC Dental
SHOW AMOUNT
PAID HERE
Total Deductions
Statement #:
22587941
Total Benefits Approved
Date:
12/21/14
Amount You May Owe Provider
Amount Due:
$125.00
Total covered benefits approved for this claim: $16.20 to IMAGING RADIOLOGISTICS LLC 12-1
_______________________________
CURRENT
PATIENT ACCT#
INQUIRIES: 773-302-9874
22587941
December 21, 2014
254789
RSM
HealthCare
123584
SIGNATURE
AMOUNT TENDERED
VISA
281.44
ACCT:*******1245
EXP:*****
APPROVAL:9999
CARDHOLDER: JANE SMITH
TOTAL PAYMENT
281.44
-----------------------------
EXPIRATION DATE
$65.00
10/18/14
$5.00
SUBTOTAL
259.00
SALES TAX
21.45
TOTAL
281.44
---------------------------------------------------------
Total covered benefits approved for this claim: $16.20 to I
CHECK CARD USING FOR PAYMENT
ABC
Dental
Chicago Medical Group
---------------------------------------------------------
44
Your 10% Coinsurance Amount..............
Total Deductions
-$1.80
Total
covered benefits
approved for this claim: $16.20 to IMAGING RADIOLOGISTICS LLC 12-12-14
Amount
Due:
$125.00
$65.00
12/10/14
DATE: 12/31/2014
$200.00
PARTICIPATING PROVIDER OPTION (PPO REDUCTIO
Total #:
Benefits
Approved
22587941
Statement
Make Checks Payable to
CHECK CARD USING FOR PAYMENT
Make Checks Payable to
-----
90-120 DAYS
Totals
Deductions
1.80
Your 10% Coinsurance Amount..............
22587941
18.00
-$27.00
Deductions
Customer Name: Jon G. Castro
$125.00
Total
Reminder: Please include
Terms: Balance due in 30
PG.5
Customer Name: Jon G. Cast
Statement #:
Learn more at f lexiblebenef it.comCURRENT
$65.00
30-60 DAYS
60-90 DAYS
90-120 DAYS
90-120 DAYS
AMOUNT
DUE:
12/21/14
Amount Due:
$125.00
866-472-5351
$65.00
22587941
Date:
Generally, an Explanation of Benefits (EOB) from your insurance company or an itemized statement
from the provider should include all of the necessary information. Please note that provider
statements containing a “balance forward” amount and credit card or cash register receipts are
not sufficient for the purposes of substantiation.
4.
How do I substantiate my debit card transactions?
Your debit card transactions can be substantiated online through your participant account
at www.flexiblebenefit.com. When you logon and view your claims information, all of the
transactions that require substantiation will be listed in a category called “Needs Receipts.”
You can scan and upload the appropriate documentation and attach it to the claim, or you can print
a customized coversheet that contains all of the claim details and use it to fax, mail or email the
information to Flex.
5.
Will I be notified when substantiation is required?
Yes, if a transaction cannot be automatically substantiated, then you will receive an email from
Flex requesting additional information. If we do not have an email address on file for you, then we
will mail a letter to your home. If the information is not received after the initial notification, then
you will receive additional reminders that substantiation is required.
6.
What happens if I don’t substantiate a transaction?
If substantiation is not received in accordance with your plan—normally within 30 days of the
transaction—your debit card will be suspended and you will not be able to use your debit card for
new purchases until the outstanding transaction is substantiated. If your debit card is placed in
suspended status, you will receive a communication from Flex to let you know.
7.
What happens if my debit card is suspended?
Your debit card can be reactivated if you send the information necessary to substantiate the
outstanding charge. Please note that it take 2-3 business days for reactivation once the
documentation is received and the transaction has been substantiated.
PG.6
Learn more at f lexiblebenef it.com
866-472-5351
8.
My debit card has been suspended. Can I still access my FSA?
Yes, if you ever have to pay out of pocket for any reason, you can file a claim with Flex and we
will reimburse you. You will still need to provide the appropriate documentation so that our Claims
Team can verify that the expense was eligible.
9.
What if my transaction was not eligible or I am unable to provide
appropriate documentation?
If your transaction was ineligible or if you cannot provide the requested documentation, you may
instead pay back the plan for the unsubstantiated amount or use other unreimbursed expenses to
offset the charge.
10. I’ve had debit cards in the past with other FSA providers and never had to
substantiate a transaction before. Why do I have to do this with Flex?
The IRS updates their regulations regarding substantiation periodically and Flex follows the
most current regulations, which include the need to verify transactions which do not follow
the guidelines for auto-substantiation.
PG.7
Learn more at f lexiblebenef it.com
866-472-5351