Frequently Asked Questions About Your Consumer Accounts MasterCard Card 1. What is the Consumer Accounts MasterCard Card? The Consumer Accounts MasterCard Card is a special purpose financial debit card linked to your: Health Care Flexible Spending Account (FSA), Health Reimbursement Account (HRA), and/or Dependent Care Flexible Spending Account. Use your Consumer Accounts Card SM to quickly and conveniently draw from your tax-advantaged account(s) to pay for eligible expenses such as: pharmacy prescriptions, doctor office copayments or over-the-counter health care items. 2. How does the Consumer Accounts Card work? Your Consumer Accounts Card allows you to access health or dependent care tax-advantaged funds at the time of purchase, eliminating the need to fill out claim forms for reimbursement of eligible expenses. Card transactions are validated at the time you pay for the expense to ensure conformance with IRS guidelines and your employer s specific plan. Once the card transaction is completed and you sign your receipt, funds from your tax-advantaged account(s) are automatically transferred to the merchant, physician or other health care vendor (or facility). For medical, dental and vision claims, your Consumer Accounts Card can work at the point of service for either copay expenses or coinsurance and deductibles, depending on how your employer has configured the program. Substantiation by copay and real-time RX: All swipes for medical, dental and vision expenses must match the copay amounts under your plan dollar for dollar. Swipes for any other amount will be declined. Swipes for RX will be processed in real time for any amount, provided the claim is processed through the pharmacy benefit manager system. Substantiation by Merchant Category Code and real-time RX: Swipes can be processed for copay, coinsurances, deductibles and other eligible out-of-pocket expenses for network providers. However; please note that charges at the point of service may not reflect an accurate contracted or discounted rate. Be sure the charged amount is correct prior to swiping for expenses at medical, dental or vision provider. Swipes for RX will be processed in real time for any amount, provided the claim is processed through the pharmacy benefit manager system. Please check with your employer if you have any question regarding how your card program is set up. 100-6094 08/06 1816 2006 Harvard Pilgrim Health Care 1
3. What expenses are eligible for use with my Consumer Accounts Card? Generally, your Card can be used to pay for: Pharmacy prescriptions (copays, deductibles, full or discounted charges). Copayments at your doctor s office, hospital, or other health care center Certain over-the-counter health care items Dependent care expenses, if you have a Dependent Care FSA. Coinsurance, deductible or other out of pocket expenses for medical, dental and vision expenses if your employer has elected this functionality. Consult your enrollment materials or log onto myharvardpilgrim.org familiarize yourself with what services, locations, and products are eligible for use with your Consumer Accounts Card. The plan provided by your employer may contain certain restrictions on Card use, so it is important to review these materials thoroughly. You are responsible for making sure that you use the Card for only those services or items covered by your plan. 4. Who can use the Consumer Accounts Card? You and any covered dependent(s) in your Harvard Pilgrim Health Care plan can use your Consumer Accounts Card at approved locations that accept MasterCard. Two cards are sent to you for your convenience and additional cards may be requested by calling Customer Service at 866-755-2648. 5. How do I activate my Consumer Accounts Card? Review the information sent to you with your new Card, including the Terms and Conditions. Sign the back of the Card and then call the toll-free number on the activation sticker affixed to the Card to complete the activation process. Additional Cards sent to you for your dependents are to be signed by them. Only one phone call is necessary to activate all Cards. Please wait until your plan s effective date before attempting to activate your Card. You may begin using your Card one business day after activation. 6. What if I choose not to activate my Consumer Accounts Card? If you decide not to activate your Card, you will need to file manual claims reimbursement from your tax-advantaged account(s). For your protection, destroy your Card by cutting it in half. 7. How do I use my Consumer Accounts Card at the pharmacy? Present your Card at the drug store to pay the amount you owe for your prescription. (copay, deductible, discounted or full charge). Sign the receipt to show your agreement with the charge and to acknowledge that you are using your Card for an eligible expense. Funds will automatically be transferred from your FSA and/or your HRA directly to the pharmacy, assuming there are adequate funds in your account(s). Keep a copy of the receipt for your records. You will need to present them in the event you are audited by the IRS. 100-6094 08/06 1816 2006 Harvard Pilgrim Health Care 2
8. How do I use my Card to pay my copayment at the doctor s office, emergency room or other medical facility where a copayment, coinsurance, deductible or other out of pocket expense is required? The process will be different based on what your benefit plan allows. If your employer has chosen: Substantiation by copay: Use your Card to pay the copayment portion of the charges you have incurred during a visit to your doctor s office, hospital or emergency room by offering the Card as the method of payment. Advise the person who is processing your payment to only put through the charges that are equal to the copayment amount printed on your Harvard Pilgrim Health Care ID card. If you receive more than one service and you have to pay more than one copayment, the transactions must be processed separately even if they are incurred during the same medical treatment. MCC substantiation: Use your Card to pay for out of pocket expenses incurred at the point of service for network providers. Please note however, that charges at the point of service may not reflect contracted or discounted rates. Be sure the charged amount is correct prior to swiping for expenses at medical, dental or vision provider. 9. Can I use my Consumer Accounts Card to pay for a bill I receive in the mail? Yes. If your merchant or provider accepts MasterCard simply provide the Card number, expiration date, and any other information requested to pay eligible expenses. Be sure the charged amount is correct prior to providing your Card number for billed expenses at medical, dental or vision providers. Review your Explanation of Benefits and make sure the charge on the bill matches the patient responsibility indicated on the EOB. 10. Can I use my Consumer Accounts Card at online pharmacies or for mail order prescriptions? Yes. Enter your Consumer Account Card number online or on the order form. Remember, if you do not have enough money in your tax-advantaged account(s), your transaction will be denied. 11. Can I use my Consumer Accounts Card to purchase over-the-counter health care items? Yes, visit our online pharmacy on myharvardpilgrim.org to purchase eligible over-the-counter items and conveniently pay for them with your Consumer Accounts Card. Although over-the-counter expenses may be eligible for reimbursement under your plan, only certain pharmacies or retailers can electronically substantiate your purchases with the Consumer Accounts Card. Go to myharvardpilgrim.org for a list of pharmacies or retailers where you can go to purchase OTC health care items with your Card. To receive reimbursement for eligible OTC items purchased at nonparticipating locations, send your receipts along with a claim form to our claim center. 12. If asked to enter debit or credit at a MasterCard terminal, which one do I choose? If you are asked to select debit or credit, select credit, even though it says debit on your Card. Your Card does not require a PIN (personal identification number) for processing. 100-6094 08/06 1816 2006 Harvard Pilgrim Health Care 3
13. Can I use my Card to pay for the entire bill at my doctor or dentist s office? For substantiation by copay value: No. Your Consumer Accounts Card gives you convenient access to your funds to pay eligible copayments only. Your doctor or dentist will bill your medical or dental plan for the remaining portion of the bill. For MCC substantiation: Yes, however the charges at the point of service may not reflect contracted or discounted rates. Be sure the charged amount at your network provider is correct prior to swiping for expenses at medical, dental or vision provider. 14. Can I use my Card to access prior year FSA/HRA account balances? No, the Consumer Accounts Card can only access the available balance in your current FSA/HRA plan year. Prior year funds can be accessed with our automatic rollover option, if activated, or you may submit copies of the receipts along with a reimbursement form to our claim center. Forms can be obtained from myharvardpilgrim.org. 15. What if I use my Consumer Accounts Card to pay for a prescription, but I am also purchasing another non-eligible item, such as shampoo, at the same time? For a transaction to authorize, we must be able to match a Card transaction amount to the exact amount you owe for a covered prescription at the pharmacy. Therefore, you cannot use your Card for ineligible items; you must pay for those items separately. Remember, the IRS requires that you use the Card only for qualified expenses covered by your tax-advantaged account(s) and that you keep all of your receipts. Each time you present your Consumer Accounts Card for a payment you will sign a receipt. Your signature acknowledges that the charges represent qualified FSA or HRA expenses. 16. How long is my Consumer Accounts Card valid? The expiration date can be found on the face of the Card. It is valid for four (4) years from the date of issuance. 17. What if I decide not to use my Card anymore? If you no longer wish to use your Card, simply call the number printed on the back of your Card to cancel and cut the Card up. 18. What do I do if my Consumer Accounts Card is rejected when I use it? If your Card doesn t work at the time of purchase or a transaction is declined: Choose another payment method, such as cash or check; Save your receipt and submit your claim manually along with a reimbursement request form. You can download claim forms from myharvardpilgrim.org or call Customer Service for assistance. If you are enrolled in auto-rollover, you can rely on our automatic claim submission process to submit the claim for you (except for non-online over-the-counter drug purchases, which must be submitted manually). 100-6094 08/06 1816 2006 Harvard Pilgrim Health Care 4
19. What are some reasons why my Consumer Accounts Card transactions may be declined? If your Card is rejected it may be because: Your Card has not been activated. One business day has not passed since activation. The transaction is not for an eligible service or it does not match a pre-defined benefit, copay amount, as required by your plan. The transaction is for a medical, dental, vision deductible or coinsurance charge and your employer has not elected this functionality. The transaction cannot be substantiated in real time at your pharmacy. There are insufficient funds in your tax-advantaged account(s) to cover the expense. There is a problem with the merchant s card terminal. You are attempting to swipe at an invalid location, e.g. a gas station or electronics store. 20. What do I do if I have a charge that exceeds the amount available in my tax advantaged account? If you attempt to use your Card for an amount that is greater than the available balance in your tax-advantaged account, the entire transaction will be declined. Fund balances are available online at myharvardpilgrim.org or by calling the number on your Consumer Accounts Card. 21. Can I have a negative balance in my FSA and/or HRA? Yes. The transaction information for the Consumer Accounts Card is updated daily. However, there could be an instance when the Card is used on the same day that a manual claim is received and the total amount of both services results in a negative balance in your account. If this occurs, we will advise you of overpayment procedures. 22. What happens if an expense is only covered by my FSA but my employer wants me to use my HRA funds first? Your Card uses funds from your accounts in the order designated by your employer (for example: HRA funds first, then FSA funds). If an expense is not eligible under the account designated to pay first, the charge will automatically roll over to your other account for payment authorization. If authorized, payment goes directly from your account to the pharmacy. 23. When are funds available in my tax-advantaged account(s)? Generally, you have Card access to your tax-advantaged funds once those funds are deposited into your account(s) and three business days following Card activation. Certain rules apply to the different types of accounts as described below: Health Care Flexible Spending Account (FSA) The full amount of your annual contribution is available to you at the beginning of your plan year. Health Reimbursement Account (HRA) The full amount of the employer-sponsored funds designated for your account is available to you at the beginning of your plan year. Dependent Care Flexible Spending Account You can only access funds that you have already contributed to your account prior to the time the service is rendered. You cannot access any money that you have not already deposited into your account. There may also be a lag between the time your money is withheld from your paycheck and the time it is actually deposited into your account, so go online at myharvardpilgrim.org or call the number on your Consumer Accounts Card to verify your account balance. 100-6094 08/06 1816 2006 Harvard Pilgrim Health Care 5
24. What if my Consumer Accounts Card is lost or stolen or I suspect that my Card has been used fraudulently? If your Card is lost or stolen, call us immediately at 1-866-755-2648. If you report the incident to us within four (4) business days, you will not be liable for fraudulent use. You may be liable, for a maximum of $50, if you fail to report the loss within four business days. It is your responsibility to monitor your account activity and report any unusual or fraudulent transactions to Harvard Pilgrim Health Care and your employer. When you report a lost or stolen Card, it will be deactivated immediately and new Cards will be reissued. 25. What type of records am I responsible for keeping when I use my Consumer Accounts Card? Always keep a copy of your itemized receipts for all Card transactions. The IRS requires you to keep documentation associated with reimbursement from your FSA and/or HRA, and you might be required to produce them in the event you are audited by the IRS. In addition, Harvard Pilgrim Health Care may determine that a particular transaction made with your Consumer Accounts Card requires additional review. If so, you will need to provide Harvard Pilgrim Health Care with the same information you would supply to the IRS to prove that you used your Consumer Accounts Card for eligible expenses. 26. Can I continue to have auto-rollover in addition to using my Card? Yes. If your employer offers auto-rollover of claims from any applicable benefit plan to your HRA and/or FSA, you can rely on this feature in addition to using your Card. 27. What if I have questions about my Consumer Accounts Card or my FSA and/or HRA? Visit myharvardpilgrim.org for answers to your questions about your Consumer Accounts Card and your tax-advantaged accounts. myharvardpilgrim.org offers extensive information to help you manage your health and health savings accounts, such as: Account balance information Recent transactions Instructions on Card use Eligible expenses Details about your specific plan You may also call the toll-free number on the back of your Consumer Accounts Card for: Card balance information Card transaction information Reporting a lost or stolen Card Questions about a charge that appears on your Card statement Questions about the Card not working at a merchant Ordering additional Cards 100-6094 08/06 1816 2006 Harvard Pilgrim Health Care 6
28. Will I get a separate paper statement for my Consumer Accounts Card? No, your Consumer Accounts Card transactions can be viewed with your FSA/ HRA statement. 29. Can I receive a separate statement? Harvard Pilgrim Health Care strives to control your healthcare insurance costs. One way is to combine the Flexible Spending Account/ Health Reimbursement Account and Consumer Accounts Card statement. Therefore, we are not making paper statements available. 30. When will I receive my paper statements for my Consumer Accounts Card? You will be receiving paper statements detailing the activity in your Flexible Spending Account/Health Reimbursement Account on a semiannual basis. This will show all activities on your Consumer Account Card for that period. 31. Can I receive a paper statement on a quarterly basis? Harvard Pilgrim Health Care strives to control your healthcare insurance costs. One way is to combine the Flexible Spending Account/Reimbursement Account and Consumer Accounts Card statement. 32. What if I need to see if activities on my Consumer Accounts Card were posted correctly before the paper statement is sent to me? You can view your account activity via myharvardpilgrim.org or by calling the customer service number on the back of your Consumer Accounts Card. 33. How quickly can I see my account activity? It takes 3 business days to settle a debit card transaction. Once the card transaction is received at Harvard Pilgrim Health Care, the information is made readily available to you. 34. What if I don t have access to the internet to view my online statements? You may call the customer service number on the back of your card to obtain details about your Consumer Accounts Card activities. If you have a question about your FSA and/or HRA benefits, call the Customer Service number found in on your medical ID card and in your plan materials. 100-6094 08/06 1816 2006 Harvard Pilgrim Health Care 7