Health Reimbursement Account & Section 125 Cafeteria Plan Take Care Debit Card Policy & Procedures: Campbell Clinic Plan Year: January to December This manual covers your company s specific plan design for your HRA/FSA Plan. This will cover policies regarding your Take Care debit card as well as information for manual claim submission as well. THANK YOU PAGE 1
P for CPN HRA/FSA Policy & Procedures UTake Care Debit Card Helpful HintsU: The Take Care Debit Card is used for the below: UNOTE:U A Take Care debit card substantiation claim form UMUSTU accompany all follow up documents for Take Care charges. - Participants with the HRA Plan ONLY: a. Card is used for Medical and prescription* expenses ONLY b. EOB (Explanation of Benefits) will be required for all medical charges. - Participants with the FSA Plan ONLY: a. Card is used for medical, dental, vision, prescriptions* and qualified OTC items. b. EOB/Itemized statement will be required for all medical charges. c. Itemized statement will be required for all dental and vision charges. - Participants with both HRA and FSA Plan: a. HRA will pay first for Medical and prescription* expenses ONLY nd b. UOnce All HRA moniesu have been used, the FSA Plan will pay 2P Medical and prescription expenses. c. FSA Plan will also pay for Rx, dental, and vision expenses. d. EOB (Explanation of Benefits) will be required for all medical charges. e. Itemized bill will be required for all dental and vision charges. NOTE: Participant s who have USingle HRA coverage and enrolled in the FSAU must UNOTU use their take care card to pay for dependents medical expenses until ALL their Single Coverage HRA money has been used. If funds still remain in the participants Single HRA plan and a medical expense needs to be claimed for a dependent, the participant UMUSTU pay out of pocket and file the claim manually against the FSA plan using the Flexible Spending Reimbursement Claim Form. ULIMITED FSA Plan - If you are a participant who is enrolled in the FSA LIMITED PLAN. Your take care debit card can only be used for UVisionU and UDentalU expenses ONLY. An itemized bill will be required for substantiation for dental charges. PAGE 2
- Prescriptions purchased at any Non-Receipt Retailer (Ex: Walgreens, Wal-Mart, Target, Kroger, etc.) will be auto-substantiated (not requiring a follow up receipt) on participants accounts. To view a list of all the IIAS or 90% Retailers, follow the below instructions: i. Go to 27TUhttp://www.sig-is.org/U27 T ii. Scroll to the bottom right and click on the links below: a. IIAS Merchant PDF (these retailers will allow the card to be accepted and will auto-substantiate, not requiring a follow up receipt). b. 90% Merchant PDF (these retailers will allow the card to be accepted BUT will always require a follow up receipt for substantiation). - Effective July, 1, 2009, Any prescription/otc purchased at a Retailer other than an IIAS or 90% merchant, the take care card WILL NOT BE ACCEPTED. CPN has no control over this as it is between each specific retail/drug store and the IRS. - *Effective January 1, 2011, OTC drugs and medications cannot be reimbursed from an FSA or HRA unless they are accompanied by a doctor s prescription. The ruling does not exclude all OTC expenses. Items like aspirin and cough syrup would be out, unless a doctor s prescription is obtained for their use. However, diabetic test strips and blood glucose monitors can still be purchased on a pre-tax basis without a doctor s prescription. Participant MyFlexOnline Login Instructions: These instructions are for FIRST TIME USERS only If a participant has already created their user name and password they may skip this step and go to www.cpnflex.com / Click Employee Login / and enter their User Name & Password and click on LOGIN. Creating a MyFlexOnline Account: a. Go to www.cpnflex.com b. Click on Employee Login c. Click on New User Registration d. Complete required information which will include creating a user name and password. If a participant has misplaced their user name and/or password, they may view their user name and/or reset their password by completing these steps: a. Go to www.cpnflex.com b. Click on Employee login c. Click on Password Reset and User Name Retrieval d. Complete required information and the next screen will show participants user name and the option of resetting their password. PAGE 3
Take Care Debit Card Request: The Dependent Care Spending Account is NOT ELIGIBLE for the Take Care debit card. Once cards have been requested, card delivery is estimated between 10-14 business days and will be delivered to the home address of the participant. If a participant indicated they did not want a card at their initial enrollment set up and changes their mind, they may simply go to their MyFlexOnline account and request their card and their second card for a spouse or dependent. Estimated delivery time from the date of request is 10-14 business days and will be sent to the participant s home address. Take Care Debit Card Activation: Once the participant receives their Take Care Debit Card in the mail, it is ready to be used. NO ACTIVATION IS REQUIRED PAGE 4
MyFlexOnline Activity: When you log into the secure MyFlexOnline portal, you can access the below 24/7: - Check your account balance - File claims - Look up eligible expenses - Print account statements - See your savings - Verify your elections - Review your payments - Manage direct deposit - Change your settings Take your flex plan with you: Apps for iphone and Android Need to check your balance, file a claim or submit an EOB/itemized statement while checking your provider? Now, you can, with the app for iphone and Android. They re FREE! Just search for MyFlex at the itunes App Store or Google Play. To log in, use the same ID and password as you do for the MyFlexOnline website. Stay in touch with email/text notifications. Maybe, you d like to get a text when your claim is processed. Well, now you can! Just log into MyFlexOnline and go to Settings to sign up for notifications. CONTACT US This screen lists contact information for Corporate Planning Network, Inc. HOURS OF OPERATION Monday-Friday (8am-4pm CST) Local: 901.756.8244 Toll Free: 800.737.0125 Fax: 901.756.8322 Email: claims@cpnflex.com E-ticket: Send your question by submitting an e-ticket to CPN from our website, www.cpnflex.com and receive your answer within 24* hours. *Requests submitted on a Friday, may take up to 72 hours for a response. PAGE 5
P of P of CPN HRA/FSA Policy & Procedures Take Care Debit Card E-mail Notifications: st Take Care Debit Card Notification e-mails are sent out around the first (1P P) week of each month to participants who are pending follow up documents (EOB/Itemized bills/receipts) for charges on their account. If a participant is not pending any documents on their account, they WILL NOT be generated an e-mail. The Take Care Debit Card e-mail is not sent by CPN, Inc., but is an electronic system generated notification. Thus, it is very important that each participant checks their Junk Folder or SPAM filter and make sure to allow e-mails from noreply@flexbenefitcard.com It is also highly recommended that each participant have an active and working personal e-mail address listed on their MyFlexOnline account in order to receive these notifications. Take Care Debit Card Suspension Policy: Participant s Take Care Debit Card will be subject to suspension for the below reasons: 1. Delinquent Charges - Once a participant swipes their Take Care debit card, the system will give the charge a Deadline Date if the charge requires follow up documentation. Deadline date st is 1P the month following 30 days from date of charge. Example: John Doe pays a medical bill on 1/15/2014. The system will require an EOB (Explanation of Benefits) for substantiation for this charge amount. Therefore, the Deadline Date to submit the EOB will be 3/01/2014. The participant will have until their Deadline Date to submit their EOB/itemized statements, or their Take Care debit card will be placed on a temporary suspension until the EOB/itemized th statement is received and the charge has been substantiated. Suspensions occur on the 15P each month. 2. Balance Dues Take Care debit cards will also be suspended for any outstanding Balance Due that has not been paid back to the plan. A Balance Due can be one or more of the following: 1. If a participant over pays a charge according to the amount listed on their EOB (Explanation of Benefits). 2. Uses their Take Care Debit Card for services rendered within a previous plan year. You CANNOT pay for services rendered in a prior plan year. 3. Participant cannot supply the proper documentation for a Take Care debit card charge. 4. Participant pays for non-qualified services (cosmetic surgery, etc.) PAGE 6
Non-Qualified Expenses: Once the Take Care debit card claims operator receives each participants claim form as well as follow up documents, if an expense is marked as non-qualified*, the amount will be adjusted and will then create a Balance Due on the participants account they will be responsible of paying back to CPN (see Debit Card Suspension Policy on page 6). *Non-Qualified Expenses can be any or all of the below: 1. If a participant over pays a charge according to the amount listed on their EOB (Explanation of Benefits)/Itemized Statement. 2. Uses their Take Care Debit Card for services rendered within a previous plan year. You CANNOT pay for services rendered in a prior plan year. 3. Participant cannot supply the proper documentation for a Take Care debit card charge. 4. Participant pays for non-qualified services (cosmetic surgery, etc.) Balance Due Repayment Policy: Balance Dues can be paid by Personal Check made payable to CPN or online from the participants MyFlexOnline account. Payments made by check need to be mailed to the below address: Corporate Planning Network, Inc. PO Box 1748 Cordova, TN 38088 Attn: Debit Card Repayment When the participant logs on to their MyFlexOnline account, they will notice the Amount You Owe and the balance due shown in red (Example: Amount You Owe: $375.39) at the top of their account they must repay. In order to repay, they may click on the link Click here to repay the Amount You Owe for non-qualified card payments. If a participants Take Care debit card has already been suspended due to the amount not being paid back in a timely manner, when the participant logs on to his/her MyFlexOnline account it will bring up their Flex Debit Card Tab informing them their card has been suspended. They may then click on the link provided: Click here to view explanation, which will direct them to the screen where they can repay their balance due amount. PARTICIPANTS ARE NOT TO HAVE A MERCHANT CREDIT THEIR CARD TO PAY BACK A BALANCE DUE ON THEIR ACCOUNT!!!!!! PAGE 7
Take Care Debit Card Reactivation Policy: Take Care debit card reactivations for unsubstantiated charges/balance due payments occur daily for any participant who has sent in proper documentation for delinquent charges and/or paid their balance due in full; which caused the suspension of their card. Example: If substantiation is received and adjudicated on Monday, the card will be reactivated on Tuesday (after overnight update*). *If substantiation is processed on Friday, card reactivation will not occur until the following Monday. If a participant has a suspended card at the end of a plan year, their Take Care debit card for the new plan year will be on a suspended status until their previous plan year account is in good standing (Meaning all charges requiring follow up documentation have been received and/or any balance due paid). Take Care Debit Card Substantiation Claim Form Process: When a participant is required to submit their EOB/itemized statement for one or more charges made with their Take Care card, they may do so by using one of the following options: 1. Go to www.cpnflex.com and under the Employee / Forms, they can print the Debit Card Substantiation claim form. The participant will complete and send along with their IRS required follow up documents to CPN s customer service department. Claim forms can also be found under Forms located on the Home Page as well. 2. The participant may also create their ICE (Internet Claim Entry) Form for their debit card charges online. Simply log on to their MyFlexOnline account and from their Benefits screen click on Verify Card Use. There they can click on the charge(s) they wish to add to their ICE Form and follow the steps for completion. 3. Participants may Submit a Claim for reimbursement, or substantiate a debit card swipe by using the MyFlex Mobile App (see page 5 for more information.) 4. Your company has the $500 carryover provision. PAGE 8
Lost/Stolen or Fraudulent Activity Take Care Debit Card Process: If a participant does not receive their Take Care debit card in the mail or it becomes lost or stolen, they need to contact the Lost/Stolen Card Center Hotline to report their card so the bank can request a replacement card with brand new card number. Lost/Stolen Hotline: 866.679.7649 It is extremely important that the participant verifies with the bank to make sure they have their correct mailing address on file. Please allow 10-14 business days for the replacement card to arrive. Fraudulent charges discovered on an account must be reported within 90 days from date the charge was made. Fraudulent/Dispute hotline: 866.297.3619 (Option #4) Monday-Friday, 8am to 5pm, CDT. PAGE 9