Welcome to your health accounts

Transcription

1 GUIDE TO YOUR HEALTH ACCOUNTS: HEALTH FSA, LPFSA, DCFSA AND HRA Be ready for the speed of life

2 Bank of America, N.A. Member FDIC Welcome to your health accounts from Bank of America Life moves fast. That s why it s important to be ready for tomorrow with your health accounts today. We re pleased your employer has chosen Bank of America for your health accounts to help you pay for qualified medical expenses. This guide contains information on one or more accounts you have selected through your employer: Health Flexible Spending Account (Health FSA) Limited Purpose Flexible Spending Account (LPFSA) Dependent Care Flexible Spending Account (DCFSA) Health Reimbursement Arrangement (HRA) If you have one account or a combination of these accounts, you ll find everything you need to know about setting up and managing your accounts and learn how to maximize their tax advantages. Check with your employer if you need more information on which accounts are available to you. Now, let s get started! Which accounts do I have?...04 Summary chart of health accounts...05 Tax benefits for all...06 Health Flexible Spending Account (Health FSA) What is a Health FSA?...08 Cool tools...09 Health FSA tips...10 Contribution limit...11 Limited Purpose FSA (LPFSA) What is an LPFSA?...12 Cool tool...13 LPFSA tips...13 Contribution limit...13 Dependent Care FSA (DCFSA) What is a DCFSA?...14 Contribution limit...14 Cool tool...14 DCFSA tips...14 Health Reimbursement Arrangement (HRA) What is an HRA?...16 Cool tool...17 HRA tips...17 Contribution limit...17 Getting started Your health account checklist ways to pay...22 Health account Visa debit card...24 Managing your accounts Member website...28 Receipt storage...30 Need a form?...31 How to file a claim...32 Substantiating a transaction

3 Chart your health accounts Here s a summary of the main features of each health account type and how some accounts can work together. How it works Which accounts do I have? To find out which account or account combinations you have, check your benefits summary or go to myhealth.bankofamerica.com and click on the Annual maximum contribution limit for 2017 Health FSA LPFSA DCFSA HRA HSA Allows you to set aside pre-tax dollars to help pay for qualified medical expenses that occur during a 12-month period. Your employer can also choose to contribute to your Health FSA. Like an FSA, but typically offered in combination with an HSA. Can only be used for qualified dental and vision expenses. A reimbursement account that uses pre-tax dollars for dependent care expenses including daycare, after-school care and adult care. An employer-funded account that helps you pay for qualified medical expenses not covered by your health plan. A tax-advantaged personal health care account that works with an HSAqualified health plan to pay for current and future medical expenses. Based on employer plan rules and income limitations, but typically up to $5,000. Although there is no set limit, it s subject to antidiscrimination rules. $3,450 (individual) $6,900 (family) $1,000 catch-up contribution for those age 55+ Based on employer plan rules, but typically up to $2,650. Accounts tab. If you have an HSA, you can also access our HSA user guide. Do unused funds in your account carry over to the next year? When is the money in your account available for use? Can it be combined with another health account? 04 Up to $500 if your employer allows. The full contribution amount is available on the first day of coverage in your plan year. Yes, with a DCFSA or HRA. No, funds must be Yes, refer to your used during the employer for plan year. specific details. Yes, unused balances carry over. It s yours to keep and you never lose it even if you change jobs or stop working. Funds are available as soon as contributions are deposited into your account throughout the year. Yes, with a Health FSA, LPFSA, HRA or an HSA. Yes, with a Health FSA, DCFSA. Yes, with an LPFSA and/or DCFSA. 05

4 Tax benefits for all Every health account has a unique set of tax advantages that can help you make the most of your health care dollars. Your contributions and reimbursements for qualified expenses are tax free. Take a look at the chart below to understand the tax advantages of each account: Account Health FSA LPFSA DCFSA HRA HSA What are the tax advantages? Contributions you make to your account that are used to pay for qualified medical, dental and vision expenses are tax free. Contributions you make to your account that are used to pay for qualified dental or vision expenses are tax free. Contributions you make to your account that are used to pay for qualified dependent care expenses are tax free. Reimbursements for qualified health care expenses are tax free. Offers a triple tax advantage: 1. Pre-tax contributions 2. Potential for tax-free interest and investment earnings 3. Tax-free payments for qualified medical expenses Health FSA FYI Some states do not allow pre-tax employer or employee contributions to health care accounts. Consult with your own attorney or tax advisor to understand the tax and legal consequences of a Health FSA and/or HRA plan account and how it could impact your particular situation

5 Health Flexible Spending Account (Health FSA) What is a Health FSA? A Health FSA is an employer-sponsored reimbursement account that allows you to set aside pre-tax money on an annual basis to pay for qualified medical, dental and vision expenses. A pro-rated portion of this amount is automatically deducted from your paycheck each pay period and allocated to a Health FSA established on your behalf. FSAs are compatible with all types of health insurance plans and are made available to you by your employer. Advantages Allows you to pay for out-of-pocket medical expenses using tax-free funds. And, your total contribution amount is available to you on the first day of coverage in the plan, so you can start using your FSA for qualified health care expenses immediately. How it Works You need to pay for a minor surgery. Cool tools FSA calculator Helps you determine how much you should contribute. Calculate the savings. Note: Remember, your employer sets the contribution limits within the IRS maximums. Debit card 1 You receive a Bank of America Health Account Visa debit card credited with your annual contribution amount. You can use this card wherever Visa is accepted to pay for doctor visits, trips to the pharmacy, or even for qualified health care purchases when shopping online. When you use your Visa debit card, qualified medical charges are automatically paid from your account. Your contribution amount for the year is $2,400 Your total contribution amount is available to you on January 1. Your plan starts January 1 Not all plans start at the beginning of the calendar year. Check your employer s plan document for details. Your are paid bi-monthly so in this case your pre-tax payroll deduction would be $100 per pay period. In February, you are able to pay the entire bill for your surgery that costs $2,000 Works with other health accounts If you have another account combined with your FSA, like an HRA, here s how the accounts work together: if you make a debit card purchase, the funds will come out of your FSA first, up to the available balance. Then, your HRA kicks in to cover the rest

6 Health FSA Tips 1. Determine the amount of money you would like to contribute for the year based on your anticipated out-of-pocket costs for medical, dental, vision and prescription expenses. 2. You are eligible to be reimbursed up to your annual election amount from the first day of coverage, even if you have not yet contributed the full amount. 3. Any unused funds remaining in your account at the end of the plan year will be forfeited, unless your employer has opted in for the $500 carryover under plan guidelines. 4. Always save your receipts and documents! You may have to provide proof that the expense is qualified. See page 34 for more about substantiation. 5. A Health FSA is not portable if you change companies or terminate employment.* Contribution limit The maximum contribution to a Health FSA is $2,650 per year as set by the IRS. However, your employer can choose to set a lower amount. This amount is indexed for inflation and may change from year to year. You decide how much to contribute to your individual account with pre-tax dollars. Health FSA $2,650 *If you have questions about accessing your plan after you leave your job, be sure to consult your company s benefits representative. Does the money in a Health FSA carry over year after year? 2 Typically, money in a Health FSA will not carry over year after year and any unused contributions remaining in your Health FSA at the end of the plan year will be forfeited. However, your employer can opt in for a carryover option of up to $500 under plan guidelines. Expenses that can be paid with a Health FSA Medical services such as office visits, annual physical exams Prescribed health care products Preventative dental care, orthodontia, eyeglasses, contact lenses and laser eye surgery Copayments, coinsurance and deductibles Acupuncture, chiropractic services and more Want to check if a medical expense is qualified? Check this list

7 Limited Purpose Flexible Spending Account (LPFSA) What is an LPFSA? An LPFSA is an employer-sponsored reimbursement account that allows you to set aside pre-tax money on an annual basis to pay for qualified dental and vision expenses. It s typically used in combination with an HSA. Advantages Allows you to set aside up to $2,650 in pre-tax contributions to pay for qualified out-of-pocket dental and vision expenses. If you have an HSA, you can use your LPFSA to cover specific dental and vision expenses, up to the available balance, so you can save your HSA funds for future qualified health care needs. How it Works You need to pay for braces and have an HSA and LPFSA. See the tax savings: LPFSA $2,650 HSA $6,900 Total $9,550 Tax bracket 25% Tax savings $2,387 Orthodontia estimate $4,800 Remember, you can be reimbursed for qualified dental and vision expenses incurred during the benefit year. Payment from an LPFSA cannot be made until after the service has actually been provided. Dental coverage $1,000 Total budget needed $3,800 1st: LPFSA balance < $2,650 > 2nd: HSA funds < $1,150 > Braces paid in full $ 0 Cool tool Debit card You receive a Bank of America Health Account Visa debit card credited with your annual contribution amount. You can use this card wherever Visa is accepted to pay for qualified dental and vision expenses or even when shopping online. When you use your debit card, qualified dental and vision charges are automatically paid from your LPFSA. If you have another health account, such as an HSA, and your LPFSA is depleted or suspended due to outstanding substantiation, the funds will automatically be deducted from your HSA. LPFSA Tips 1. Determine the amount of money you need based on your anticipated out-of-pocket costs for dental and vision expenses. 2. You are eligible to be reimbursed as you incur dental and vision expenses. 3. Any unused funds remaining in your account at the end of the plan year will be forfeited, unless your employer has opted in for the $500 carryover under plan guidelines. 4. Always save your receipts and documents! You may have to provide proof that the expense is qualified. See page 34 for more about substantiation. 5. An LPFSA is not portable if you change companies or terminate employment.* *If you have questions about accessing your plan after you leave your job, be sure to consult your company s benefits representative. Contribution limit Based on employer plan rules, but typically up to $2,650 for the 2018 plan year. Expenses that can be paid with a LPFSA Preventative dental care, orthodontia, eyeglasses, contact lenses and laser eye surgery Copayments, coinsurance and deductibles for dental and vision Prescribed dental and vision products Want to check if a dental or vision expense is qualified under your LPFSA? Check this list

8 Dependent Care Flexible Spending Account (DCFSA) What is a DCFSA? A DCFSA lets you use pre-tax dollars to pay for eligible expenses related to care for your child (under age 13), disabled spouse, elderly parent, or other qualified dependent who is physically or mentally incapable of self-care. You can use funds from a DCFSA for costs for dependent care while you re working, looking for work or attending school full-time. Contribution limit You can set aside up to $5,000 in pre-tax contributions to pay for dependent care expenses. How it Works Here are the ways you can pay for eligible dependent care expenses: 1 Use your debit card 2 Pay out of pocket and get reimbursed 3 Submit for a one-time reimbursement for your provider by filling out a Reimbursement Request Form 4 Make recurring payments to a care provider by submitting a Recurring Dependent Care Form Forms: For more information on forms, see page 31 for details. Cool tool DCFSA calculator Calculate how much to contribute to your DCFSA and see your potential tax savings. DCFSA Tips 1. Payment from a DCFSA cannot be made until the expense has been incurred. Example: If you pay for childcare for the entire month of January on January 1, you will not be able to be reimbursed until after January A DCFSA is not portable if you change companies or terminate employment.* *If you have questions about accessing your plan after you leave your job, be sure to consult your company s benefits representative. HRA 14 15

9 Cool tool Health Reimbursement Arrangement (HRA) What is an HRA? An HRA is an added medical benefit sponsored by your employer that accompanies your health care plan. Your employer allocates a pre-determined amount of contributions to this account on your behalf. You can then access those funds for qualified health expenses that are not reimbursed by your employer s health plan or any other source. Advantages Funds are a benefit provided by your employer to help you pay for qualified health care expenses. Based on your employer s plan rules, funds may roll over each year. Use the money to help offset qualified health expenses not covered by your insurance plan. Debit card You ll receive a Bank of America Health Account Visa debit card credited with your annual contribution amount. You can use this card wherever Visa is accepted to pay for qualified medical, dental and vision expenses or for qualified health care purchases when shopping online. When you use your debit card, qualified expenses are automatically paid from your HRA. If your HRA is paired with an FSA, you will have the convenience of having one debit card with the combined balances. Your FSA balance will always be used first. HRA Tips 1. HRAs are compatible with all types of health insurance plans and are owned by your employer. 2. Money left in an HRA at the end of the year may roll over to the next year, depending on employer plan rules. 3. Depending on employer plan rules, you may lose access to funds if you switch health plans. 4. Always save your receipts and documents! You may have to provide proof that the expense is qualified. See page 34 for more about substantiation. 5. An HRA is not typically portable if you change companies or terminate employment* Every HRA plan is different, because every employer is different. Your employer sets the rules for eligible expenses, annual limits, and amounts that can be rolled over. Check your benefit plan summary to find out what your employer covers. *If you have questions about accessing your plan after you leave your job, be sure to consult your company s benefits representative. Contribution limit Your employer sets the contribution amount, based on plan rules

10 Want to get started together? We can walk you through the process and answer any questions you may have along the way. Online chat available 8:00 a.m. 8:00 p.m. (Eastern) Monday - Friday Getting started Call one of our Customer Care associates available 24/7 You can find the number on the back of your debit card For TDD, call:

11 Getting started. Your health account checklist. Ready to take control of your health care accounts? In just a few easy steps you ll be on your way. The member website helps you easily manage your account, view your contributions, submit claims, securely store receipts and more. Get started today! Visit the member website at myhealth.bankofamerica.com. Activate your Visa debit card Once you ve received your debit card in the mail, be sure to activate it immediately by calling the number on the label on the front of the card. Take a tour of the member website and mobile app Get the MyHealth mobile app 3 It s your health account on the go. Download the MyHealth BofA app directly from the App Store SM or Google Play TM. 4 Verify your , mailing address and phone number So we can reach you, make sure we have your current , mailing address and phone number. If additional information is ever needed for your account activity, we ll contact you by or phone. Set up direct deposit for faster reimbursements Many people prefer the speed and reliability of direct deposit to receive their claim reimbursements. After you ve linked your bank account, you ll receive funds electronically in 2-3 business days. Add dependents To add dependents, you ll need to have their dates of birth and social security numbers handy. Go to the Profile tab and choose Add Dependent. Update your notification preferences You can also sign up for text alerts for some notifications. Authorize other users (optional) You have the option to allow others to contact Customer Care or make transactions on your account on your behalf. Learn more on page 31. Request a health account debit card for your dependents (FSA, LPFSA, HRA only) Once you ve added dependents, you can order them additional cards. This is really helpful when you have older children, especially ones going off to college. Go to the Profile tab and choose Banking/Cards and then choose Issue Card

12 3 ways to pay There are three convenient ways you can access the funds in your health accounts to pay for qualified health care expenses. 1. Use your Health Account Visa debit card Swipe your card at the checkout or use your debit card to pay any bills you receive from your provider. Amounts will automatically be deducted from your account (see page 25 for more details). 2. Pay your provider When you receive an invoice from a health care provider for a qualified expense, you can pay it directly from your health account just like an online bill pay service. A check will generally be mailed within 3-5 business days. Just log in to the member website and click on File a Claim. 3. Pay yourself If you ve already paid for qualified products or services out of your own pocket, you can reimburse yourself from the funds in your health account either electronically or by check. Log in to the member website and click File a Claim. FYI Save your receipts! Upload and store your receipts using the MyHealth mobile app so you have them handy if you ever need them to substantiate a claim. Refer to page 34 for more information on substantiation. Expenses not covered by your health care plan? Use your FSA, LPFSA, or HRA to pay for qualified out-of-pocket health care expenses that aren t covered by your regular health plan. These include items such as doctor s office co-pays, pharmacy items, or even for qualified health care purchases you make when shopping online. Over the counter medications (OTC)? The IRS requires a prescription for OTC medicines when paying with a health account. Ask your doctor to write a prescription for medicines or supplies that you frequently need so you can use your health account to pay for these items. Check this list of commonly covered health care expenses

13 Your Health Account Visa debit card, no ordinary debit card The easiest way to pay for qualified health and dependent care expenses is with your debit card. Use it at doctors and dentists offices, at your dependent care provider, or for prescriptions and other qualified products and services, even when shopping online. Even if you ve checked the appropriate list of health care expenses, it can sometimes be challenging to keep up with all the subtleties. So, if you need to pay for your acupuncture appointment, buy contact lenses or pay for a prescription, just use your debit card. Always be sure to check the list of commonly covered health care expenses. How your accounts work together with your debit card LPFSA + HSA DENTAL & VISION 1st When paying for dental or vision expenses, the money comes out of the LPFSA first, up to the available balance. Health FSA + HRA QUALIFIED HEALTH CARE EXPENSES 2nd If no more funds remain in the LPFSA, then dental and vision expenses will come out of the HSA. If you have more than one health account with Bank of America, your debit card automatically knows which account to take the funds from based on the expense category. Now that s smart! 1st When paying for qualified health care expenses, funds will come out of the Health FSA first. 2nd Once funds are no longer available in the FSA, then the HRA is used. Order cards for each dependent (up to a total of 9 for anyone 18 or older) Order cards for each of your dependents so everyone has easy access to health care, no matter where your family members may roam

14 Lost or Stolen Card? Call our Customer Care Center immediately at You can also report a lost or stolen card on the member website or the MyHealth mobile app. 5 Dispute a Transaction Many times a single unauthorized charge is found to be a merchant error. Simply contacting the merchant might resolve the error quickly. If you suspect fraud or error on your Health Account Visa debit card, please contact Customer Care to report the charges as soon as possible. Debit Card transaction dispute process 1. Contact Customer Care at the number on the back of your debit card 2. Customer Care cancels any debit cards and issues new cards 3. Customer Care sends you a Transaction Dispute Form* to complete Managing your accounts 4. A temporary credit will be placed on your account 5. Once the form is submitted, the disputed charges will be researched. This can take up to 30 days 6. If the disputed charges are confirmed as incorrect, the temporary credit will change to a permanent credit 7. You ll be notified by mail when the dispute process is completed TIP *The Transaction Dispute Form must be completed and submitted as soon as a disputed/ fraudulent transaction is identified and must be received within 120 calendar days from original transaction date. Sign up for debit card alerts to be notified when your card has been used. Go to the Statements & Notifications tab on the member website and click on Notification Preferences

15 Managing your accounts Whether you want to see your balance, check the status of a claim, or update your account information, it s easy to do with our member website or MyHealth mobile app. Member website myhealth.bankofamerica.com Receipt storage Electronic receipt storage for your medical bills. Forms Any forms you may need can be found under Tools & Support. Quick links Get to the options you use the most like filing a claim, managing expenses and more. Message center View messages concerning your health accounts. If action is required on your part, you can simply click the message and you will be taken to the page that requires your attention. Account statements Quarterly statements will be generated and available on the member website within 2 business days of the first month of the quarter. And, if you ve got more than one health account, your account information will be consolidated in one statement. Quick view: See your election summary and paid claims by category. Use the various filters and graphs to better understand spending patterns and to help you plan your elections for future years

16 More about managing your account Receipt storage This convenient feature allows you to upload and store an electronic copy of receipts for medical expenses. You can view receipts for unpaid claims, or attach them to a transaction for payment. Receipts will be stored for 7 years. There are two ways you can upload receipts: MyHealth mobile app 1. From the home screen, select Expenses 2. Create New Expense 3. Enter the expense, date of service and amount 4. Select Upload Receipt to take a picture of your receipt 5. Select Add Expense to upload the receipt 6. Hit Submit Member website 1. On the Expense Summary tab, select Add Expense 2. Enter the description, date of service and amount 3. Upload a receipt 4. Click Add Expense Need a form? Most forms you need you can be found on the member website under the Tools & Resources tab including: Authorized User Form Authorizes release of medical information to an authorized user. Automatic Orthodontia Reimbursement Form Use to receive automatic reimbursements from your health account for recurring monthly charges for orthodontia expenses. Medical Necessity Form For any dual-purpose expenses for which you are requesting reimbursement (defined as having both a medical purpose and personal, cosmetic, or general health purpose). Reimbursement Request Form Use for the reimbursement of an out-of-pocket expense. Recurring Dependent Care Form Must be completed each plan year to set up recurring reimbursement for dependent care expenses. In some cases, you will need to call the Customer Care Center to request a form, including: Claim Appeal Form Use this form if you disagree with a decision regarding your claim for benefits and want to request an appeal. External Claim Appeal Review Form To be used if you are requesting an external review with an Independent Review Organization because you do not agree with the decision of Bank of America concerning your internal claim appeal. Transaction Dispute Form Use when a dispute/fraudulent transaction is identified. What happens if I submit a form that is incomplete or incorrect? One of our Customer Care associates will call you to help

17 How to File a Claim The easiest way to file or pay a claim is on the member website, or through the MyHealth mobile app. On the member website: 1. Select File a Claim 2. Select an account to Pay From 3. Select who to Pay To Note: When choosing Someone Else, you ll be prompted to add or select a payee. 4. Upload valid documentation (See page 34 for more information) 5. Enter the required information 6. Enter mileage, if applicable 7. Choose Next 8. Read the summary, check the box and Submit Using the MyHealth Mobile app: 1. Choose File a Claim 2. Select Add a New Payee or Pick a Payee 3. If you need to add a new payee, enter all their information and select Save Payee at the top right 4. Enter the required claim details 5. Upload your receipt by taking a picture with your phone 6. Hit Add Claim at the top right For details on filing deadlines, visit the Accounts tab on the member website and click on the plan name. Watch a quick video on how to file a claim Medical Necessity If you file a claim for medical necessity and the claim is denied, we ll need you to provide proof that the product or service was for a medically necessary reason. The process differs depending on the claim type, but first you ll receive a Request for More Information (RMI) notification, which you ll need to complete with the reason of medical necessity: Manual/online claim If the completed Medical Necessity Form is submitted within 10 days of receiving the letter and the reason is approved, the claim will be processed and paid. If not, the claim will be marked as overdue and you will have 30 days to return the completed form. Otherwise, your claim will be denied. Debit card claim If the completed Medical Necessity Form is submitted within 10 days of receiving the letter, the claim status will be updated to received. Otherwise, a Final Debit Card Receipt Request is sent. If you submit the form within 10 days of this request, the claim status will be updated to received. If not, then a Denial with Request for Repayment is sent, and the use of funds from the impacted account will be suspended for 30 days

18 Substantiating a transaction Substantiating online claims What is substantiation? Member website & mobile app process: Substantiation is proof that the purchase is a qualified expense. Because health accounts are tax deductible, the IRS requires validation for purchases made on your health account. In some cases, a transaction will be automatically substantiated due to the nature of the expense. However, there will be other times Claim filed Claim and supporting documentation reviewed Documentation complete Documentation needed The transaction will be processed. Payment will be received within 2-3 business days via direct deposit (7-10 business days if check payment). We ll send you receipt reminder notifications (up to 3) requesting the proper documentation. when you will be asked to provide documentation to confirm the purchase was for a qualified expense. If we need additional information, you ll receive a letter letting you know that more information/documentation is required before your claim can be paid. If we don t receive documentation within 60 days, the claim will not be paid. When this occurs, you will need to provide a receipt or Explanation of Benefits (EOB) that includes: Manual/online claims notifications We will communicate with you throughout the entire claims process so you know Name of person incurring expense what s outstanding or required. Date of service Amount charged 7385 NC HWY 73 DENVER, NC PH: (704) st receipt reminder sent 5 days after claim submission Merchant/Provider name Type of service Sample receipt 2nd receipt reminder sent 15 days after claim submission 3rd receipt reminder sent 30 days after claim submission FYI A debit card receipt with just the date, provider and amount is not typically valid for substantiation. Request for More Information (RMI) sent to let you know more information/ documentation will be needed before your claim can be paid Denial letter sent 60 days after claim submission or if the claim is Note: The Internal Revenue Service defines qualified medical care expenses within IRS Section 213(d). Medical care expenses are further defined as amounts paid for the diagnosis, cure, mitigation or treatment of a disease, and for treatments affecting any part or function of the body. denied due to ineligibility Denial with Repayment sent if a claim has been paid, but then determined ineligible 34 35

19 Substantiating debit card transactions Debit card transaction process: Debit card purchase made at health care provider or merchant Claim and supporting documentation reviewed Documentation complete Documentation needed Debit card notifications Claim will be approved. We ll send you receipt reminder notifications (up to 3) requesting the proper documentation. After 40 days, if we haven t received the documentation, or if the transaction is determined ineligible, you ll receive a denial letter with a repayment request. If we haven t received repayment after 60 days, the debit card for that account will be suspended. We will communicate with you throughout the entire claims process so you know what s outstanding or required. 1st receipt reminder sent immediately after debit card transaction settlement date 2nd receipt reminder sent 15 days after debit card transaction settlement date Overdue notice sent 30 days after debit card settlement date Request for More Information (RMI) sent to let you know more information/ documentation will be needed before your claim can be substantiated Ineligible notice denial with repayment request sent 40 days after debit card settlement date or if the claim is denied due to ineligibility. If we haven t received repayment after 60 days, the debit card for that account will be suspended Watch this short video on how to substantiate a claim How to submit documentation Once you ve been notified that we need additional documentation, you can submit receipts or other paperwork in one of three ways: 1. Using the MyHealth mobile app upload a receipt image. 2. On the member website select Upload Receipt next to the claim and follow the prompts to submit your receipts. 3. By fax send a copy of the receipt, along with a completed health account Reimbursement Request Form. See page 31 for details. You will receive a decision on reimbursement within 30 days after the documentation is received. If your substantiation is denied If you receive a denial letter or ineligible notice and you disagree with the decision, you can appeal the denial. To appeal, you ll need to call the Customer Care Center for next steps. Remember, not all debit card purchases will require substantiation. Some transactions will be automatically substantiated including: Most copayment amounts under your health plan Prescriptions Real time verification at point of purchase Recurring payments (may be recognized and flagged, which could eliminate the need to submit receipts) Choose your notification preferences You can choose online or print for how you prefer to receive Denial/Denial Repayment notifications. All other substantiation notifications will be available on the member website under the Statements & Notifications tab, and an will be sent notifying you when a new notice is available. If we don t have an address on file for you, we ll send a letter in the mail

20 We re here to help. If you have any questions, you can reach us by: Online chat 8:00 a.m. 8:00 p.m. (Eastern) Monday - Friday Calling one of our Customer Care associates available 24/7 You can find the number on the back of your debit card For TDD, call: This document is intended to be a guide. Always consult your employer s plan document for specifics. Case studies are examples meant for informational purposes only and may not be real customers. Please consult your tax or legal advisor regarding specific use of health accounts. The computer screen images shown in this guide are intended to illustrate the functionality and services available to participants on the member website. They are not meant as exact representations of the screens available to you. Bank of America does not sponsor or maintain the Flexible Spending Accounts (FSA) or Health Reimbursement Accounts (HRA) that you establish. The programs are sponsored and maintained solely by the employer. Bank of America acts solely as claims administrator performing administrative tasks pursuant to an agreement with, and at the direction of, the employer. The employer is solely responsible for ensuring such arrangements comply with all applicable laws. Eligible Expenses: Contact your employer for a description of eligible expenses actually covered under your Health FSA/HRA. Your employer may limit the scope of expenses covered under the Health FSA/HRA. 1 This Health Account Visa debit card program is issued by Bank of America, N.A. Visa is a registered trademark of Visa International Service Association, and is used by the issuer pursuant to license from Visa U.S.A. Inc. 2 Health FSA plans may be amended to permit a maximum of $500 of unused amounts remaining at the end of a plan year to be carried forward to the subsequent plan year OR they may allow for a 2 ½ month grace period. Employers who so choose may only offer one of the available options: either the carry forward OR the 2 ½ month grace period. It is not permissible to have both provisions in the plan for a given year. Employers may also choose to offer neither option, so you should check with your employer if you have any questions. 3 Data connection required. Wireless carrier fees may apply. Mobile app is available on most devices. 4 Apple, the Apple logo, iphone, and imac are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Android, Google Play, and the Google Play logo are trademarks of Google, Inc. 5 Charges must be reported within 60 days of receiving statement Bank of America Corporation. All rights reserved. ARNHKKXM 11/

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