Plan Sponsor s How-To Guide

Transcription

1 Plan Sponsor s How-To Guide

2 Table of Contents Description Location Employer Request for Service Form Slide 3 Enroll/Terminate a Participant Slide 4 Navigating the Employer Site Slide 5-9 Navigating the Member Portal Slide 10 Substantiation Process Slide How to Submit a Manual Claim Slide Discrimination Testing Slide 17 Leave of Absence Process Slide 18 Plan Sponsor s How-To Guide * 2

3 Employer Request for Service Form The Employer Request for Service may be used to change the company s name/address and to add/remove an authorized contact. Employer Request for Service Form When the form is submitted to Ameriflex, we require the following information: Company Name Plan Administrator Name Telephone Company Address City State Zip When a change is requested, be sure to complete all pertinent information under the appropriate section. Date and signature are required for processing any changes. The completed form can be submitted via fax to , or ed to your dedicated Account Executive. Plan Sponsor s How-To Guide * 3

4 How Do I Enroll/Terminate a Participant? To Enroll a New Participant: Once a participant meets the waiting period specified in your plan documents, the participant has 30 days to elect to participate. The Electronic Upload Spreadsheet is our preferred method for enrollment. It can be found at under Employer Employer Forms To Terminate a Participant: Once a participant is terminated, the last day worked is the last day he/she is eligible to incur new charges. The employer will need to notify Ameriflex of the termination immediately. Termination Form: Employee Termination/Leave of Absence Form Plan Sponsor s How-To Guide * 4

5 How to Navigate Employer Login Sites Employers may access claims invoices by going to To view further information about logging in to our Claims Invoice Manager site, proceed to slide 10. Employers may access participant account information by going to To view participant demographics and reports, click on the following tabs: Employers Login Flex Employer Login Portal Plan Sponsors, Administrators, and Employers The User ID and password will be provided to you by your dedicated Account Executive. If you need your employer password reset, reach out to your dedicated Ameriflex contact, who will be able to provide you with a temporary password to view the employer account. For further instructions on the employer site, proceed to slide 6. Plan Sponsor s How-To Guide * 5

6 Ameriflex Employer Portal Employers may access participant account information by going to Log in as an employer by entering the User ID and password provided to you in your Welcome . If you cannot locate this information, reach out to your dedicated Ameriflex contact. Enter the employee s full Social Security number on the top menu. If you do not have the employee s Social Security number, you may click on the magnifying glass on the top left of your screen to search by name or another identifier. Please note that the entire name of the employee or only the first and last initials of the employee s name may be entered in the fields provided. You will be able to view an employee s demographics, a dependent s demographics, and/or the benefit account types. Employee Demographics Employee name, address, phone number, Social Security number, gender, and date of birth. Dependent Demographics - Dependent name, address, phone number, Social Security number, gender, and date of birth. Benefit Account(s) Account types, plan years, election amounts, disbursed balance, and remaining balance. Plan Sponsor s How-To Guide * 6

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8 Claims Invoice Manager System Employers may access claims invoices by going to Ameriflex Invoice Manager. An is sent from with your user ID and password upon the initial set up. Your user ID will be your full address. If you do not remember your password or do not recall the , click on Forgot Password? to obtain a new password. An will be sent from Ameriflex (noreply@myameriflex.com) with a new password. To view individual invoices: Select the month by clicking on the drop-down arrow provided. Click on View Details to open an invoice. To print, click on Excel or Print at top of invoice. You may need to add no-reply@myameriflex.com as a safe sender to receive the notifications. Plan Sponsor s How-To Guide * 9

9 How to Navigate Employee Sites Please see the following website instructions for participants to create an online account: Member Portal Login Instructions & Login Site Click on the Member Portal login option under the Members menu on When you are prompted to enter your User ID and Password, click on Register and follow the instructions to complete the registration process. You will need your Member ID (SSN) and Myameriflex Card number (or Ameriflex Group ID if you do not have a Myameriflex Card). Participants are able update demographic information*, access dependent(s) information, request a new card for yourself and/or qualified dependents, access detailed eligible expense list, the Ameriflex Member Services team, or opt in and out of member communications. Participants are able to reset their own passwords by clicking on Forgot your password? Click here. If they encounter any difficulties, our Member Service Department is available Monday Friday, 8:30am-8:00pm EST at FLEX (3539). *Please note: If your employer sends eligibility data to Ameriflex via Electronic Data Interchange (EDI), you will be unable to update your demographic information through the portal. In this case, you should contact your employer to update this information. Plan Sponsor s How-To Guide * 10

10 Substantiation Process Implemented by the IRS in 2009, manual substantiation is required for all tax-favored health care debit card purchases. This process allows the employer to remain in compliance with IRS regulations. Participants are required by the IRS to provide proof to the third party administrator (TPA) of their medical FSA plan expenses for any card transactions that do not fall under the following autosubstantiation processes. P.O.S. (Point of Sale)/Real-time verification: An automated process in which the vendor absorbs the substantiation obligation by feeding the medical-eligible subtotal electronically through each approved debit card swipe. An example of this process is the IIAS (Inventory Information Approval System) that is now required by the IRS for all pharmacies. A full list of IIAS-certified pharmacies can be found by following this link: Copayment matching: The employer group can provide Ameriflex with a copy of their Benefit Summary showing all current copays for the medical plans. Ameriflex can then enter the copay dollar amounts into our system so participants will not be asked for substantiation on transactions that match the copay amounts exactly. To ensure that your company is set up for copayment matching, please forward a copy of your Benefit Summary to your Account Executive. Recurring expenses: Ameriflex will verify all prior expenses for the current plan year. If a charge exists from the same provider for the same exact dollar amount, Ameriflex will auto-substantiate the new charge. Plan Sponsor s How-To Guide * 11

11 Substantiation Process cont. Participants will receive their first substantiation request via notification. Note: if the participant does not have an address in the system, a letter will be sent to the current address via mail. This notification will direct them to the Member Portal to review their pending transactions. Upon receiving the notification, substantiations can be submitted by using one of the convenient methods provided below: Participant Portal: Myameriflex Portal Myameriflex Mobile App: Downloadable on Google Play or the Apple App Store Fax: , Attention: Claims Department Claims@myameriflex.com Standard Mail: Ameriflex Claims Department, P.O. Box , Plano, Texas If the substantiation documents are not received after the second notice is sent, the Myameriflex Cards associated with the account will be deactivated until the plan year ends or the transaction is resolved. Please note that while a card is deactivated, participants can still submit manual claims for expenses incurred and paid for out of pocket. Only the functionality of the card is deactivated during this time. Is there an option for an employer to waive the substantiation process? Yes, there are options available to employers regarding substantiations. Please contact your dedicated Account Executive for more information. Plan Sponsor s How-To Guide * 12

12 MyPlanConnect makes getting reimbursed from your spending account easy! It electronically compiles claims data for easy electronic claims submission. It can also match your FSA and/or HRA card swipe to approved transactions, eliminating substantiations! Benefits: HR Managers & Employers: Eliminate participant complaints and headaches with regards to their spending account management with MyPlanConnect. Members & Participants: Get reimbursed faster from your spending account without all of the paperwork hassles with MyPlanConnect. For more information on MyPlanConnect, please speak to your Account Executive directly! Plan Sponsor s How-To Guide * 13

13 How to Submit a Manual Claim If an employee has paid out of pocket for medical expenses, they may submit a manual claim for reimbursement. Participant Portal: Employees may enter and upload claim requests and supporting documentation to expedite their reimbursement. Employees can also utilize our Pay Provider feature and have reimbursements sent directly to the employee s medical provider. Mobile App: Employees can take pictures of their itemized receipts and Explanation of Benefits (EOB), and submit their claim through our mobile App. The Myameriflex Mobile App is available for FREE through the Apple App Store and Google Play. Claims@myameriflex.com Please advise employees to retain a copy of the for your records. Fax: , Attn: Claims Department. Please advise employees to retain a copy of the fax confirmation for their records. Standard Mail: Employees may send a copy of their itemized receipts or EOB along with the Claim Form to: Ameriflex Claims Department, PO Box , Plano TX Plan Sponsor s How-To Guide * 14

14 How to Submit a Manual Claim cont. Claims Reimbursement Time Frame Check Reimbursement: A check will arrive to the employee 2-3 weeks from the date the claim is processed. Direct Deposit Reimbursement: A direct deposit will be sent to the employee s bank account in 3-5 business days from the date the claim is processed. Direct Deposit Form. Over-the-counter drugs/medicines: Include a copy of your medical provider s prescription and a pharmacy receipt showing the prescription number. Orthodontia Expenses: Orthodontia expenses require that both of the following be submitted with the initial claim: (1) proof of payment (e.g. provider bill indicating payments or credit card receipt); and (2) a copy of the orthodontia contract, including amount, down payment, monthly fees, and estimated length of treatment. Plan Sponsor s How-To Guide * 15

15 How to Submit a Manual Claim cont. Health Reimbursement Accounts (HRA) For those who must meet a portion of their deductible prior to having access to the HRA funds, the HRA Activation Form, along with an Explanation of Benefits (EOB) from the insurance carrier showing the amount of the deductible met year to date, is required. HRA Activation Form If an employee has met more than their out-of-pocket portion of the deductible, they may request to be reimbursed from the HRA by completing a Claim Form. Recurring Claim Submission for DCA Expenses Employees have the option of submitting a recurring claim to Ameriflex for the entire plan year. To set up a recurring claim, please see the Instructions section on the Claim Form. Commuter (Parking and Transit) Expenses Currently the IRS does not require the substantiation of Commuter claims, so an itemized receipt/bill is not required. NOTE: The IRS does not permit reimbursement for expenses older than 180 days from the date incurred. Plan Sponsor s How-To Guide * 16

16 Discrimination Testing In order to provide tax savings, cafeteria plans must not discriminate in favor of highly compensated employees (HCEs) or key employees (Keys). It is recommended that testing be ran at the start of the plan year, at the close of the plan year, and anytime that you have any significant changes within the company (i.e. major layoff/hiring, drastic salary changes, etc.). Ameriflex provides an online Discrimination Testing Portal for our FSA, DCAP, and HRA clients. The discrimination testing tool, along with other discrimination testing information, can be found in the Employer Portal at There is an instructions button on the top of the spreadsheet with information on how to complete the Discrimination Testing Template. PLEASE NOTE: Ameriflex does not store these results. It is the plan sponsor's responsibility to save a copy of the template after performing the test. Should you have any questions about the portal, please refer to the instructions box first before contacting me. The portal is not an information station to see rules and regulations that pertain to non-discrimination testing. It's only purpose is the actual testing of plans that Ameriflex administers. Plan Sponsor s How-To Guide * 17

17 Leave of Absence Process It is very important that Leave of Absences are communicated to Ameriflex so that we do not post contributions to accounts if the member is on leave and not making payroll deductions. If the participant is continuing their health FSA benefit during leave, please let us know how: 1.With after-tax dollars, by sending monthly payments to the employer by the due date established by the employer. 1.With pre-tax dollars, by having such amounts withheld from the participant's ongoing compensation (if any), including unused sick and vacation days, or prepaying all or a portion of the contributions for the expected duration of the leave on a pre-tax salary reduction basis, out of pre-leave compensation. To prepay contributions, the participant must make a special election to that effect prior to the date that such compensation would normally be made available (NOTE: pre-tax dollars may not be used to fund coverage during the next plan year). 1.Under another arrangement agreed upon between the participant and the employer (e.g., the plan administrator may fund coverage during the leave and withhold catch-up contributions from the participant's compensation on a pre-tax basis) upon the participant's return. Plan Sponsor s How-To Guide * 18

18 Contact Information Ameriflex Contact Information Member Services FLEX (3539), option 0 Dedicated Ameriflex Contact Name, ext Team Manager Name, ext For a full list of our products, please visit our website. Plan Sponsor s How-To Guide * 19

19 Thank You