Health Savings Accounts (HSAs)

Transcription

1 Health Savings Accounts (HSAs) What does the Beniversal HSA provide? Tax-free savings on eligible medical expenses for today and tomorrow. A savings opportunity! You own the account. Funds carry over from year-to-year, earn interest or can be invested. Convenient access to account funds through the Beniversal Prepaid Mastercard for HSA. Friendly and knowledgeable Participant Services representatives to assist with your questions. Visit Investments in securities, through UMB HSA Saver are: Not FDIC-Insured May Lose Value No Bank Guarantee

2 What is a Health Savings Account? A Health Savings Account (HSA) is a tax-free account used to pay for outof-pocket medical expenses such as the deductible, coinsurance, and other expenses not covered by the health plan. To contribute to an HSA, individuals must be enrolled in an HSA-compatible health plan. The HSA-compatible health plan provides comprehensive coverage once the minimum deductible is reached. What you need to know about an HSA: YOU OWN THE ACCOUNT. As the owner of the account, you determine when you want to spend the funds. YOU NEVER LOSE THE FUNDS. Once funds have been deposited into your account, they are yours to keep. There is no use-or-lose provision. You even keep the funds if your employment changes. TAX-FREE SAVINGS FOR MEDICAL EXPENSES. An HSA is the only account to provide a triple-tax benefit. Funds are deposited into the HSA tax-free, funds grow tax-deferred and remain tax-free when used for eligible medical expenses. This saves you 30-40% on every dollar you contribute to the HSA. FUNDS GROW. Funds in an HSA earn interest or can be invested. Note: States can choose to follow the federal tax-treatment guidelines for HSAs or establish their own; some states tax HSA contributions. If you have questions about your tax implications, consult your tax advisor. HSA funds used to pay for non-qualified medical expenses are subject to income taxes on the amount and a possible additional 20% penalty, if you re under age 65. Who is eligible for an HSA? To contribute to an HSA, you must meet the following criteria: 1. You must be enrolled in an HSA-compatible health plan. (Your employer can provide more information on the health plan(s) that meet the requirements for an HSA.) 2. You may not be enrolled in any other health plan that is not a qualified HSA-compatible plan. (If you or your spouse enrolls in a Medical FSA or HRA, you may not be eligible for an HSA unless the FSA or HRA is limited to dental and vision expenses.) 3. You cannot be enrolled in Medicare. 4. You cannot be claimed as a dependent on another person s taxes. How much can I contribute? The contribution limits for an HSA are determined each year by the IRS. Contributions are based on the type of health plan coverage you are enrolled in (e.g. single or family coverage). Contributions from you and your employer cannot exceed these limits. Please visit for the current limits. When can HSA funds be used? HSA funds can be used for eligible medical expenses provided after the HSA has been established. Funds will carry over from year to year if not used. An HSA is a cash balance account. If you incur an expense before HSA funds have been deposited, you may need to pay for the expense with other funds and reimburse yourself once the funds become available. If at some point you are no longer covered by an HSA-compatible health plan, you will no longer be eligible to contribute to the HSA but can continue to use the funds in the HSA for eligible medical expenses. What are eligible medical expenses? Eligible medical expenses are determined by the IRS. In addition to typical out-of-pocket medical expenses covered by your health plan, the HSA can be used for expenses such as: dental, vision, chiropractic services, prescription drugs and certain over-the-counter medical items. Whose expenses are eligible? HSA funds can be used to pay for eligible medical expenses for you, your spouse and eligible dependents (that you may claim on your tax return). What is an HSA-compatible health plan? The HSA must by offered with an HSA-compatible health plan (often called a high deductible health plan). The plan must meet certain minimum deductible and maximum out-ofpocket requirements set by the IRS. An HSA-compatible health plan provides comprehensive coverage for medical and prescription costs once the deductible and maximum out-of-pocket are met for the plan year. Your health plan will also offer certain preventive care services before meeting the deductible. Your employer will be able to tell you which plan(s) will make you eligible for an HSA.

3 HSA Plan Comparison & Tax Savings Worksheet Plan Comparison This worksheet can assist in calculating the cost of different health plan options. Be sure to enter all values for a particular plan in a single column. An online comparison calculator is also available at HSA-compatible plan Non-HSAcompatible plan A. Enter the amount you would pay in annual premiums under each plan $ $ B. Enter the amount of the plan deductible $ $ C. Enter the amount of the maximum out-of-pocket limit $ $ D. Enter the % co-insurance (% you pay once the deductible is met) % % E. Calculate your estimated prescription drug cost 1. HSA-compatible health plan estimate = # of prescriptions X Ave. Cost (if unknown, enter $50) 2. Non-HSA-compatible plan estimate = # of prescriptions X Ave. Cost or Co-pay (if unknown, enter $50) F. Calculate your estimated doctor visit cost 1. HSA-compatible health plan estimate = # of doctor visits X Ave. Cost (if unknown, enter $150) 2. Non-HSA-compatible plan estimate = # of doctor visits X Ave. Cost or Co-pay (if unknown, enter $150) $ $ $ $ G. Enter other anticipated out-of-pocket medical expenses (e.g. hospital expenses, specialty care) $ $ H. Total Medical Expenses = Line E + Line F + Line G $ $ I. Total Medical Expenses counted towards deductible 1. HSA-compatible health plan estimate = Line H 2. Non-HSA-compatible health plan estimate = Line F + Line G J. Estimated out-of-pocket 1. HSA-compatible health plan estimate If Line I is less than Line B, enter Line I, otherwise CALCULATE a. Line I - Line B = b. Result from Line J1a x Line D = c. Result from Line J1b + Line B = d. If Line J1c is less than Line C, enter Line J1c, otherwise enter Line C. 2. Non-HSA-compatible health plan estimate If Line I is less than Line B, enter Line H, otherwise CALCULATE a. Line I - Line B = b. Result from Line J2a x Line D = c. Result from Line J2b + Line B = d. If Line J2c is less than Line C, enter Line J1c + Line E =, otherwise enter Line C + Line E =. $ $ $ $ K. Estimated cost of the plan = Line A + Line J $ $ L. Employer HSA Contribution $ Not applicable M. Net cost of the plan to you = Line L - Line K $ $ HSA Contribution Tax Savings In addition to the plan estimates listed above, the HSA-compatible plan option will provide additional tax savings on contributions and medical expenses. To calculate the estimated tax savings, complete the chart below. N. Enter estimated HSA Contribution $ O. Enter tax rate. Percentage of your gross salary that you pay in Federal, State and Local Taxes. (If uncertain, use 30%) % P. ESTIMATED ANNUAL TAX SAVINGS $ To use our online HSA calculators, please visit us at

4 Quick Reference to Eligible Expenses This list is intended to be used as a quick reference of potentially eligible medical expenses and does not guarantee that an expense is eligible. This list is not intended to be an all encompassing list and may be updated from time to time. Eligible expenses for Health Savings Accounts (HSAs) are governed by Section 213(d) of the Internal Revenue Code. In addition to the list below, there are over 150 additional items or expense types that are considered potentially eligible and may require a prescription or a letter of medical necessity. SAVE ALL RECEIPTS! You are responsible for verifying HSA funds were used for eligible expenses if ever audited by the IRS. Acupuncture Alcoholism treatment Allergy treatments (if prescribed) Ambulance Arthritis gloves Artificial limbs Artificial teeth Asthma devices and medicines (if prescribed) Bandages Body scans Braille books and magazines Breast pumps Breast reconstruction surgery following mastectomy Cancer screenings Carpal tunnel wrist supports Chiropractors Circumcision Co-insurance amounts Co-payments Counseling, when used to treat diagnosed medical condition CPAP (continuous positive airway pressure) devices Crutches Dental sealants Dental services and procedures Dentures and denture adhesives Diabetic supplies Diagnostic items/services Drug addiction treatment Drug overdose, treatment of Durable medical equipment Eye examinations, eyeglasses, equipment, and materials First aid kits Flu shots Fluoridation services Gauze pads Guide dog Hearing aids Hospital services Immunizations Insulin Laboratory fees Lactation consultant Laser eye surgery, Lasik Liquid adhesive for small cuts Lodging at a hospital or similar institution Mastectomy-related special bras Medical alert bracelet or necklace Medical information plan charges Medical monitoring and testing devices (e.g. blood-pressure monitoring devices, blood-sugar test kits/strips) Medical practitioner s fee for online or telephone consultation Medical records charges Midwife Norplant insertion or removal Obstetrical expenses Occlusal guards to prevent teeth grinding Operations / Surgeries Optometrist Organ donors Orthodontia Orthopedic shoe inserts Osteopath fees Ovulation monitor Oxygen Physical exams Physical therapy Pregnancy test kits Prescription drugs and medicines, for the purpose of medical care (not general health or cosmetic purposes) Preventive care screenings Prosthesis Psychiatric care Radial keratotomy Reading glasses Rehydration solution Rubbing alcohol Screening tests Sleep-deprivation treatment Speech therapy Stop-smoking programs Telephone equipment or television for hearing-impaired persons Thermometers Transplants Transportation expenses for person to receive medical care, may include car mileage or alternative transportation costs Vaccines Vision correction procedures Walkers Wheelchair X-ray fees Eligible Over-the-Counter Medical Supplies Adult incontinence products (e.g. Depends) Birth control products (e.g. prophylactics) Contact lens solution Denture adhesives First aid supplies (e.g. band-aids) Health monitors (e.g. blood pressure, cholesterol, HIV, thermometers) Hearing aid batteries Heat wraps (e.g. ThermaCare) Heating pads, hot water bottles Insulin & diabetic supplies Medicine dropper/spoon Motion sickness devices Supports/braces (e.g. ankle, knee, wrist, therapeutic glove) Eligible Over-the-Counter Drugs & Medicines (require a prescription) Acne medications Allergy and sinus medications (e.g. Benadryl, Claritin, Sudafed) Anti-fungal medications (e.g. Lotramin AF) Anti-itch medications (e.g. Caladryl) Cold sore medications Cough, cold & flu remedies Decongestants Diaper rash ointments Ear wax removal drops First aid creams Gastrointestinal aids (e.g. antacids, anti-diarrhea medicines, non-fiber laxatives, nausea medications) Lactose intolerance pills Motion sickness pills Nasal sprays for congestion (e.g. Afrin) Pain relievers (e.g. aspirin, Excedrin, Tylenol, Advil, Motrin) Sleeping aids Smoking cessation medications (e.g. nicotine gum or patches) Suppositories Toothache relievers (e.g. Orajel) Wart remover medications Yeast infection creams (e.g. Monistat) Once your account is open, you will have access to a detailed eligible expense look up table. Simply log in at and select Eligible Health Care Expense Table under the Documents tab.

5 How does the Beniversal HSA Work? Contributing to your HSA If you elected to make contributions through your employer, you will receive HSA contributions at regular intervals; typically it is the same as your payroll cycle. You can verify that contributions have posted to your account by logging into your accounts at If you did not elect to make contributions through your employer or if you would like to make supplemental contributions, you can make them directly by logging into the HSA Participant Site. Using your HSA funds Beniversal Prepaid Mastercard The Beniversal Card can be used at qualified merchants providing medical products and services. You simply use the card at point-of-sale to pay for eligible medical expenses. If you have other pre-tax benefit accounts, such as a Limited FSA, you will use the same card for accessing these benefits. The Card contains payment rules to identify which account the expense applies to. Online Transfers Using an HSA just got easier. Online transfers provides a flexible option to reimburse yourself when other payment methods are not accepted or available. You will be asked to link a personal checking or savings account to your HSA. Once linked you can conveniently transfer funds to/from your HSA and personal account. Bill Payment The bill payment service allows you to pay a provider directly. You can make one-time or recurring payments. Simply log into your account to get started. Regardless of how you access HSA funds, always save your receipts. Benefit Resource, Inc. will not ask for your receipts with an HSA, but if you are ever audited by the IRS, you may need to prove the funds were used for eligible expenses. Increasing your account value Benefit Resource provides you with a secure and competitive interest-bearing account through UMB Bank, n.a. Balances in the HSA are FDIC insured through UMB Bank. Additionally, once you have a balance of $1,000 or greater, you may invest HSA balances in a selection of mutual funds through UMB HSA Saver 1. Investments in securities are not FDIC insured, may lose value, and are not bank guaranteed. Accessing account information Online access: The HSA Participant Site is available through You will have 24/7 access to account information including: account balances, transactions, forms and resources, bill payment, online transfers, statements and investments (if applicable). If you have additional accounts with Benefit Resource, you will also have access to an combined account view of all of your accounts. Participant Services: Participant Services Representatives are available to assist with any of your HSA questions at (800) , Monday - Friday, 8am - 8pm, Eastern Time. 1 UMB Investment Management is a department of UMB Bank, n.a. UMB Bank, n.a. is a wholly owned subsidiary of UMB Financial Corporation. Investments in securities, through UMB HSA Saver are: Not FDIC-Insured May Lose Value No Bank Guarantee The Beniversal Prepaid Card is issued by The Bancorp Bank pursuant to license by Mastercard International Incorporated. Mastercard is a registered trademark of Mastercard International Incorporated. Card accepted at qualified merchants accepting Debit Mastercard. See Cardholder Terms and Conditions for the specific details and terms of use of the Card. HSA Custodial Services are provided by UMB Bank, n.a; Member FDIC. A separate HSA Custodial Agreement will govern the HSA Custodial Account.

6 Getting Started 1. Determine if an HSA works for you Visit our online calculators at or complete the HSA Plan Comparison & Tax Savings Worksheet to understand the financial and tax savings an HSA can provide you. 2. Determine your contribution election You will need to determine how much you intend to contribute to the HSA and consider any contributions your employer may make. Some recommendations for determining your contribution amount: 1. Fund enough to cover the deductible 2. Fund enough to cover the maximum out-of-pocket 3. Fund the annual maximum contribution TIPS: You own the HSA. Any funds you do not use in a given year will carry over and are eligible for use in future years. Also, if your needs change, you can generally change your HSA election. Ask your employer when changes are permitted. Did you know... HSAs help you save for the future. 90% of HSA participants carry a balance over year to year. The average carry over is over $1,800. HSAs limit your out-of-pocket expenses. The maximum out-of-pocket for an HSA includes all covered health and prescription expenses. If you meet this limit, you will have no co-payments or coinsurance to pay for covered in-network services. HSAs provide preventive services before the deductible. See your health plan information to learn what preventive services are covered before meeting your deductible. 3. Enroll in the HSA-compatible health plan and HSA Before you can contribute to an HSA, you will need to select the HSA-compatible health plan. Your employer will provide instructions regarding how and when enrollment will need to be completed. 4. What to expect once you enroll Within two weeks of opening the account, you will receive several items. Please watch for these closely as they contain important information regarding your account. A. HSA Confirmation Upon account opening, you will receive a Welcome from Benefit Resource. B. HSA Welcome Letter: Your Welcome Letter provides your account number, along with important information for managing your accounts. C. Beniversal Card: If you do not already have a Beniversal Card, you will receive one for use with your HSA. Follow the instructions to activate the card. Remember to always save your receipts. D. Account Statements: You will receive periodic account statements by mail. A paper statement fee applies. See your HSA Account Holder Agreement To avoid this fee, log into your account at and elect electronic statements. Questions? Visit us online: Contact us 24/7: (800) , Representatives available Monday - Friday, 8am - 8pm (Eastern Time) us: ParticipantServices@BenefitResource.com Live Chat: Via participant login at 03/2018 HSA Kenneth Drive Rochester NY Toll-free: (866) Fax: (585)

7 What to Expect during HSA Enrollment Account Opening Communication Once enrolled in a Health Savings Account (HSA) with Benefit Resource, Inc. through our partnership with UMB Bank, n.a., you can expect to receive a series of communications regarding your new account. Please watch for the following items: 1. Account Welcome (1-2 business days after account opening): Benefit Resource will send you an confirming that your account has been opened. 2. Welcome Letter (5-10 business days after account opening): You will receive a joint communication from Benefit Resource and UMB which provides your account number and other important details regarding accessing and using your account. 3. Beniversal Prepaid Mastercard (approximately 10 business days after account opening): If you have not previously received a Beniversal Card, it will arrive in a plain white envelope. It contains two cards along with card terms and conditions. If you already have a Beniversal Card for other accounts, HSA funds will be made available on the card as they become available in the HSA. See the card mailer for additional details regarding card use. Important information about procedures for opening a new account: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions and their third parties to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow your identity to be verified. You may also be asked to provide a copy of your driver s license or other identifying documents. Requests for additional information will be sent via US mail from UMB. You will be asked to respond within 15 days to ensure your account opening request can be completed and account access is not affected. Ongoing Communication Once your account has been established, you will receive the following ongoing communication items: 1. Account Statements: By default, you will receive a quarterly paper statement. There is a fee of $1.50 charged per statement, which will be deducted from the balance of the HSA. To avoid this charge, you can update your statement preference to electronic statements by logging in at BRiWeb.com. 2. IRS Form 1099-SA: IRS Form 1099-SA will be mailed by January 31 of each year to provide a record of withdrawals from the HSA. A year-end summary may be accessed from These documents, along with a W-2 from your employer, will be used to report activity involving your HSA when filing your taxes. 3. IRS Form 5498-SA: IRS Form 5498-SA is provided between April 15 and May 31 each year as confirmation of contributions to the HSA. This is provided for record keeping purposes only and does not require any action. 4. Periodic Communications: Benefit Resource may send you periodic communications regarding your account and any changes that may impact how you are using your account. Managing Your Account To ensure you have a positive experience with your HSA, please use the following contact information and resources: BRiWeb Secure Login Through BRiWeb, you will have complete access to your HSA and other benefit accounts including: detailed Beniversal Card transaction information, HSA Account Statements (Statement delivery preference), Online Bill Payment, Online Transfers and Investment Account Management. To log in, go to and click on Participants in the secure login section. If you have not already set a personalized Login ID, you will need to register with your: Company Code: Provided by your employer. Member ID: Default ID selected and provided by your employer. BRiMobile App: The BRiMobile app provides convenient on-the-go access to your account balance and transaction information. Download the BRiMobile app from the Apple App Store or Google Play. Additional information available at There are two options for logging into the BRiMobile app. (A) Use your Company Code, Login ID, and Password (B) Use your Beniversal Prepaid Mastercard and CVV Once you have successfully logged in, you can set a login PIN for future use. Phone: Contact Benefit Resource Participant Services at (800) , Monday - Friday, 8am - 8pm (Eastern Time) or participantservices@benefitresource.com. The Beniversal Prepaid Card is issued by The Bancorp Bank pursuant to license by Mastercard International Incorporated. Mastercard is a registered trademark of Mastercard International Incorporated. Card accepted at qualified merchants accepting Debit Mastercard. See Cardholder Terms and Conditions for the specific details and terms of use of the Card. HSA Custodial Services are provided by UMB Bank, n.a.; Member FDIC. A separate HSA Custodial Agreement will govern the HSA Custodial Account. 01/2018 HSA b

8 IMPORTANT INFORMATION ABOUT USING YOUR BENIVERSAL CARD FOR HSA What is a Beniversal Card? The Beniversal Prepaid Mastercard allows you to use funds from your Health Savings Account (HSA) to pay for eligible medical expenses at the point-of-sale. When can I start using my Beniversal Card? Sign your card as soon as you receive it. Use your Beniversal Card: On or after the effective date your HSA has been established. When you have funds available in your HSA. Read the sticker on the card for instructions on activating your card. What dollar amount is available on my Beniversal Card? The amount available for your HSA = the total contributions posted to your account minus any prior payments and withdrawals. Where can I use my Beniversal Card? Your card will only work at approved merchants. Approved merchants include medical providers such as: Chiropractors Doctors Dentists Hospitals Medical labs Medical supply stores Orthodontists Podiatrists Vision centers Will my card work at pharmacies and department stores that sell eligible medical items? Your card will work at pharmacies and department stores that sell eligible medical items. The Beniversal Card will not work at merchants like gas stations and restaurants. When you pay for your purchase: Have the sales clerk total your eligible medical items separately. Use your Beniversal Card to pay for the purchase. Save your receipts as documentation of your purchase. What do I need to know about making purchases with my Beniversal Card? 1. Use your card to pay for medical expenses that are eligible under your HSA as defined by the IRS in Section 213(d). 2. Do not use your card for ineligible expenses, such as teeth whitening, health club memberships or cosmetic procedures. 3. Expenses may be for you, your spouse or your eligible dependent(s) as identified on your tax return. 4. Do not use your card to pay for expenses which have been or will be reimbursed by another source. 5. A sample list of eligible expenses is available at Can I use my card to purchase over-the-counter (OTC) items? Your HSA can be used for eligible over-the-counter medical items which can be purchased with your Beniversal Card (see examples in the HSA OTC Chart at Note: As of January 1, 2011, you need a prescription to purchase eligible over-the-counter drugs and medicines. What if I order my prescription through an online or mail order program? When payment information is required for a mail order or online prescription service, you simply provide your Beniversal Card number and related account details. If asked, should I select Debit or Credit? You have the option to choose Debit or Credit. If you choose Credit, you will be asked to sign for the purchase. If you choose Debit, you will be prompted to provide a PIN. To request a PIN, call (855) Why should I save my receipts? Your HSA is regulated by the IRS. You are responsible for ensuring that funds are used for eligible expenses at all times and would be required to provide documentation of expenses if audited. What happens if I cannot provide documentation showing that card expenses were for eligible medical services? IRS regulations require you to have documentation for the total amounts withdrawn in a given tax year. If you do not have documentation for eligible expenses that you used your card for, you may use other eligible expenses as documentation. If you are audited by the IRS and cannot provide documentation of eligible expenses, you will be required to pay taxes and any penalties on all withdrawn amounts that did not have supporting documentation. -1-

9 Will Benefit Resource, Inc. or my employer ever ask me to provide supporting documentation for purchases made with my Beniversal Card for HSA? No. Your HSA is an individually-owned account. You are responsible for verifying eligible expenses and maintaining proper documentation of all expenses. Any ineligible expenses must be reported by you when filing your tax return. Can I use my card to pay for services that were provided prior to participating in the HSA? No, IRS regulations do not allow this. The date of service determines whether the expense is eligible, not the date of payment. A service is only eligible if it is provided after you have established your HSA. What if a provider requires me to pay in full at the point-of-sale, even if part of the expense will be paid from another source? Do not use your Beniversal Card if any part of the expense will be reimbursed from another source (such as your health insurance carrier). Pay the required amount with some other means and then reimburse yourself from your HSA for the adjusted expense amount. You can reimburse yourself by initiating an online transfer from the HSA to a personal account when you access your HSA Online Account. What are some reasons my Beniversal Card might not work at the point-of-sale? Your balance is less than the full expense. You attempted to use your card at a non-qualified merchant. The merchant is not registered in an eligible network. The merchant is having technical problems. The home address you gave the merchant did not match the address on file with your card. What should I do if I cannot use my Beniversal Card at the point-of-sale? If you are required to pay at the time of service, use another form of payment and reimburse yourself for the expense by initiating an online transfer from the HSA to a personal account when you access your HSA Online Account. How do I know my account balance? To view your HSA balance, as well as card transaction detail, go to or log into the BRiMobile app. Checking your account balance before using the card will help ensure you have sufficient funds to cover the entire amount of your eligible purchase. What if an expense is more than the amount remaining in my account? If the merchant can do a split transaction, tell the clerk you wish to use the Beniversal Card for the exact amount left in your account and then pay for the remaining amount separately. If the merchant cannot do a split transaction, you will need to use another form of payment. You can reimburse yourself immediately up to your account balance or wait until you have sufficient funds in your account and reimburse yourself for the entire amount. Do I need a new Beniversal Card each year? No. As long as you continue to participate in your employer-sponsored HSA, you can continue using your card through the expiration date on the card. What happens if I terminate employment? The account will remain yours and you will still be able to withdraw funds for eligible medical expenses. The trustee/custodian will assume administration of your account and will contact you directly regarding any changes that may affect your account. Where do I go for answers to my questions? Information is available 24/7 at The Benefit Resource Participant Services Department is available by calling (800) , Monday - Friday, 8am - 8pm (Eastern Time). What if I lose my card? To minimize unauthorized use of your card, be sure to report a lost card immediately by calling Benefit Resource at (800) You can request replacement cards at the same number. There is a fee associated with card replacement. Fee details are available in your Cardholder Agreement. A third party may opt to pay this fee on your behalf. Check with your plan administrator. To learn more about the Beniversal Card and to review account activity, visit the Benefit Resource website at The Beniversal Card is issued by The Bancorp Bank pursuant to license by Mastercard International Incorporated. Mastercard is a registered trademark of Mastercard International Incorporated. Card accepted at qualified merchants accepting Debit Mastercard. See Cardholder Terms and Conditions for the specific details and terms of use of the Card. HSA Custodial Services are provided by another financial institution. A separate HSA Custodial Agreement will govern the HSA Custodial Account. Rev. 09/ HSA

10 Beniversal Card Frequently Asked Questions General Beniversal Prepaid Mastercard FAQs What is a Beniversal Card? The Beniversal Prepaid Mastercard is a prepaid card that is linked to the employer benefit plans associated with your card. Your Beniversal Card may allow you to pay for eligible expenses from your Medical or Limited Medical Flexible Spending Account (FSA), Health Reimbursement Account (HRA) or Limited HRA, Health Savings Account (HSA) and/or Commuter Benefit Plan (CBP) Account. Please see your Plan Highlights/Specifications to see what accounts are available on your card. When can I start using my Beniversal Card? Before using your card, you must activate and sign the card; following the instructions received with your card. For FSA, HRA and CBP: wait to use the card on or after your effective date in the plan. For HSA: wait to use the card after your HSA has been established. What dollar amount is available on my Beniversal Card after I activate it? For an FSA, the amount available = the total amount elected for the current plan year minus any prior payments and reimbursements. For an HRA, the amount available = the total funds posted to your current plan year account minus any prior payments and reimbursements. For a CBP Account, the amount available = the total amounts posted to your account(s) minus any prior payments and reimbursements. For an HSA, the amount available = the total contributions posted to your account minus any prior payments and withdrawals. What type of expenses can I pay for with the Beniversal Card? Always refer to your plan s documentation to see what expenses are allowed under your plan. Do not use your card for ineligible expenses. For an FSA, HRA and/or HSA, expenses must be for eligible medical services/items. FSA and HRA expenses may be for you, your spouse or your eligible dependent(s), unless otherwise restricted by your plan. HSA expenses may be for you, your spouse or your eligible dependent(s) as identified on your tax return. For a CBP Account, eligible workplace commuting expenses may include mass transit and/or parking. Effective January 1, 2016, workplace mass transit expenses must be paid for with the Beniversal Card. If asked, should I select Debit or Credit? Select CREDIT to sign for the purchase or DEBIT to enter a PIN. To request a PIN, call (855) There is no ATM or cash access associated with this card. Can I use the card to pay for a service before it is provided? No. IRS regulations require that a service be provided before paying for it with medical account funds. The IRS allows one exception for medical account funds: If orthodontia expenses are eligible under your plan, payments can be based either on date of service or payment due date. What if my card does not work at the point-of-sale? For an FSA or HRA, you may pay with another form of payment and submit a claim to Benefit Resource, Inc. (BRI) for reimbursement. Log into the Benefit Resource website, go to the Submit Claims/Receipts section. Complete your claim form, then either upload it to Benefit Resource or print it so you can fax or mail it to Benefit Resource. Claims can also be submitted through the BRiMobile app available for iphone, ipad and Android devices. For an HSA, you can initiate an online transfer from the HSA to a personal account when you access your HSA Online Account at For CBP, the options will vary based on the type of expense: Mass Transit expenses must be paid with the card and are not eligible for claim reimbursement. If you are not able to use your card one month, the funds will roll to the next month and there is no loss of benefit. Vanpooling expenses can be paid with another form of payment and a claim can be submitted using a paper claim form (available from the BRI website). You can fax or mail it to BRI along with a receipt or other documentation verifying the eligibility of the expense. Parking expenses can be paid with another form of payment and a claim can be submitted. Parking claims can be submitted online at through the BRiMobile app or by completing a paper claim form and submitting it by fax or mail. What are some reasons my Beniversal Card might not work at the point-of-sale? Your card has not been activated. Your account balance is less than the full expense. You attempted to purchase items that are not eligible under your plan. You attempted to use your card at a non-qualified merchant. The merchant is not registered in an eligible network. The merchant is having technical problems. The address you gave the merchant does not match the address on file with your card. What if an expense is more than the amount remaining in my account? If the merchant can do a split transaction, tell the clerk you wish to use the Beniversal Card for the exact amount left in your account. Pay for the remaining amount with another form of payment and for FSA, HRA, HSA and eligible parking and vanpooling expenses, you can request reimbursement from the applicable account. If the merchant cannot do a split transaction, you will need to use another form of payment. For FSA, HRA, HSA and eligible parking and vanpooling expenses, you can request reimbursement from the applicable account. How can I find the balance on my Beniversal Card? Go to (24/7) and click on Participants. Log in with your Login ID and Password. Call Benefit Resource Participant Services, (800) , Monday - Friday, 8am to 8pm (Eastern Time). What if I lose my Beniversal Card? Report a lost card immediately by calling Benefit Resource at (800) Request replacement cards at the same number. (There is a fee associated with card replacement. Fee details are available in your Cardholder Agreement. A third party may opt to pay this fee on your behalf. Check with your plan administrator.) How long can I continue using my Beniversal Card? You can continue using your card through the expiration date on the card as long as you continue to participate in your employer sponsored plan. If you terminate employment or stop participating in the plan: For an FSA/HRA, you will not be able to access funds using the card. Claims for eligible expenses may be submitted for reimbursement per your Plan Highlights. For an HSA, generally you can continue to use the card as long as you remain employed and have a positive HSA balance. If you terminate employment, the account will remain yours and you will still be able to withdraw funds. You will be contacted directly regarding any changes that may affect your account at that time. For a CBP Account, account balances will be available on the card through the end of the month following the last month of eligibility. Refer to your Plan Specifications for additional information. -1-

11 Beniversal Card FSA/HRA/HSA FAQs Where can I use my Beniversal Card for eligible medical expenses? Your card will work at Qualified Merchants who accept Debit Mastercard. Qualified Merchants include medical providers such as: chiropractors, doctors, dentists, hospitals, medical labs, medical supply stores, orthodontists, podiatrists, vision centers, IIAS merchants and 90% merchants. What is an IIAS merchant? An IIAS merchant has an Inventory Information Approval System (IIAS) that automatically identifies eligible medical expenses. Here s how it works: Have the sales clerk total your entire purchase. Use your Beniversal Card first, which will automatically pay for the eligible medical items. Use another form of payment for the remaining amount. A list of IIAS merchants is available at For an FSA/HRA, you usually will not need to submit a receipt to verify the eligibility of a purchase made at an IIAS merchant, but save your receipt just in case. For an HSA, you should always save your receipts in case there is an IRS audit. What is a 90% merchant? A 90% merchant has registered with a national organization, certifying that 90% or more of its revenue is from the sale of eligible medical items. (If a merchant has more than one location, each location must be registered.) A list of 90% merchants is available at For an FSA/HRA, you usually will need to submit a receipt for a purchase made at a 90% merchant, so save your receipt. For an HSA, you should always save your receipts in case there is an IRS audit. What if a provider requires me to pay in full at the point-of-sale for a medical expense, even if part of the expense will be paid from another source? Do not use your Beniversal Card if any part of the expense will be reimbursed from another source (such as your health insurance carrier). Pay the required amount with some other means and request reimbursement from the applicable account. Can I use my card to purchase over-the-counter (OTC) items? If your Medical FSA is on the Beniversal Card, eligible OTC medical items can be purchased with your card. For an HSA, you can use your card to purchase eligible OTC medical items. For an HRA, check your plan s documentation to see if OTC expenses are eligible. Examples of OTC items are available at What should I do with my receipts when I use the card for FSA or HRA medical services/items? SAVE YOUR RECEIPTS! In fact, save all documentation related to medical expenses paid with your Beniversal Card. The documentation must include provider name, type of service, date of service and cost of service. (For prescription drugs, documentation must include the drug name.) IRS regulations require all FSA/HRA transactions to be verified for eligibility. The technology built into your card provides a way to verify many card transactions automatically. When a card transaction cannot be verified automatically, the IRS requires that you submit followup documentation. Benefit Resource will contact you when this is necessary. This often happens if you use the card for the following: Dental and vision expenses Expenses that are not co-payments under your employer-sponsored health insurance plan Expenses at a 90% merchant What if I lose my FSA or HRA receipts? See if your provider or insurance company can provide copies for you. If you cannot provide the document(s) requested by Benefit Resource or if an expense is ineligible: You may repay the expense or provide a substitute claim to offset it. If you take no action: Your FSA and/or HRA may be suspended. Your eligibility to participate in the plan may be suspended. The amount of the expense may be deducted from your wages on an after-tax basis. Card purchases not verified as an eligible expense will be reported as taxable income, per IRS regulations. What should I do with my receipts when I use the card for HSA medical services/items? Save them. You are responsible for ensuring that funds are used for eligible expenses at all times and would be required to provide documentation of expenses if audited by the IRS. When a plan year ends, will funds from that plan year still be on my card? For an FSA or HRA, see your Plan Highlights to determine the time frame funds remain available after the end of the plan year and how you can access these funds. For an HSA, balances will automatically rollover from one year to the next. Beniversal Card CBP FAQs Where can I use my Beniversal Card for eligible workplace commuting expenses? The Beniversal Card operates nationwide at approved merchants that accept Debit Mastercard. An approved merchant primarily provides transit passes and/or workplace parking. For example, you can use your card to purchase eligible services from a transit company s kiosk, ticket window or mail and ride program. You cannot use your card at non-qualified locations such as restaurants, gas stations, bookstores, department stores or grocery stores. What happens to my CBP funds at the end of each month? Unused balances at the end of a plan month will be carried forward to the subsequent plan month to be used for future qualified expenses for that account. Do I need to keep the receipts when I use the Beniversal Card for workplace commuting expenses? If a receipt for the service is provided, you should keep the receipt to comply with IRS requirements and your employer-sponsored plan. When submitting a request for reimbursement of a vanpooling expense, you must submit supporting documentation to verify the expense. There may also be times when you will be required to verify a parking expense. If you cannot provide the document(s) requested by Benefit Resource or if an expense is deemed ineligible: You may repay the expense or submit a substitute claim. Your employer may deduct the amount of the expense that has not been verified from your wages on an after-tax basis. Your CBP Account may be suspended. You may no longer be allowed to participate in the plan. The Employer maintains a Plan Document; if anything in this document conflicts with the Plan Document, then the Plan Document controls. The Beniversal Card is issued by The Bancorp Bank pursuant to license by Mastercard International Incorporated. Mastercard is a registered trademark of Mastercard International Incorporated. Card accepted at qualified merchants accepting Debit Mastercard. See Cardholder Terms and Conditions for the specific details and terms of use of the Card. HSA Custodial Services are provided by another financial institution. A separate HSA Custodial Agreement will govern the HSA Custodial Account. 01/2018 FSA/HRA/HSA/CBP