Health Care FSA Participant Toolkit
You don't want to send it. We don't want to see it. But the IRS requires it.
TRI-AD requests documentation to substantiate your claim or BenefitCard transaction because the Internal Revenue Service (IRS) requires that all claims be substantiated. Even if your incurred expense is at a medical or dental provider's office, we request documentation because we don't know what treatment procedure you had there. Remember, not all services provided by medical, dental and other healthcare providers are eligible for reimbursement through your FSA. For example, you could have had your teeth whitened at the dentist (cosmetic procedure, not FSA eligible) .
The IRS requires 5 pieces of information to substantiate every claim
Whether you're filing a claim for reimbursement, or providing documentation to back up your BenefitCard transaction, the following information must be provided:
- Provider
- Person for whom the expenses was incurred
- Date of service (not the date you were billed)
- Description of services provided
- Amount

If you do not provide all of the required information, your claim will be denied or your BenefitCard may be deactivated.
Some BenefitCard transactions do not require additional documentation
The majority of BenefitCard transactions are automatically approved and do not require backup documentation:
- Transactions that match one of the co-pays linked to your employer's health plans.
- Transactions that are processed through merchants using advanced technology that recognizes product SKU numbers as universally FSA eligible items.
- Recurring transactions that you have already substantiated with a receipt and another transaction occurs at the same merchant for the same dollar amount within the same plan year.
Some BenefitCard transactions will require follow-up documentation

Sometimes, your BenefitCard transaction will go through when you swipe, but TRI-AD will ask you to provide documentation. This happens when we don't receive all of the IRS' required information.

If you use your BenefitCard at…

…here is why you need to provide back-up documentation

Dentist office Dentists provide services such as teeth bleaching and certain veneers or coatings that are cosmetic in nature and are therefore ineligible for FSA reimbursement. Also, dentists office transactions are rarely on a copay basis.
Doctor's office Doctors sometimes provide services or treatments that are cosmetic in nature.
Optometrist/Vision Care Provider Vision care providers also sell items that are not eligible for reimbursement such as novelty contact lenses and non-prescription sunglasses.
Doctor's office for coinsurance amount The IRS does not permit auto-approval of coinsurances.
Provider's office that is not part of your company's health insurance plans If you are covered through another company's health insurance (e.g., spouse's employer, private coverage), your copays may differ from your company's coverage and will not be in TRI-AD's system.
Provider's office that doesn't transmit all IRS-required information If one or more of the required pieces of information did not get transmitted by the merchant or provider, you will need to provide after the transaction.
Small/privately-owned drugstore or pharmacy Some stores are not set up with an IRS-compliant inventory control system, so the required information is not automatically transmitted.
Health Care FSA
Limit for 2019: $2,700*
*May not apply in all plans. Check your Summary Plan Description for information specific to your plan.

FAQ

What is a Flexible Spending Account (FSA)?
FSAs allow you to deposit pretax money in an account to pay for health care and dependent care expenses that you incur during the year. There are two separate accounts that allow you to set aside pretax money from your paychecks to pay for expenses you incurred for:
  • Health Care
  • Dependent child or elder day care
How does an FSA work?
Health Care Flexible Spending Account
A health care account allows you to pay for out-of-pocket health care expenses not covered by insurance with pre-tax dollars. You can request that your company set aside money from your paycheck before taxes are deducted. This amount will be deposited into your Health Care FSA. After you incur an eligible health care expense, simply submit your claim with your receipts. You will be reimbursed from your Health Care FSA.

Dependent Care Flexible Spending Account
A dependent care account allows you to pay for costs of dependent care that lets you and your spouse work or attend school full-time. This account may be used for costs associated with the care of a child age 12 and under, a disabled spouse or other dependent such as an invalid parent, who needs care.
Why should I participate if I have health coverage?
You could save a significant amount on your taxes. The amount you elect to contribute to a flexible spending account is deducted from your gross pay before taxes. To help estimate your individual savings, see the Tax Savings Calculator on this Toolkit.

Actual savings will depend on many factors including your household income and tax filing status. In some cases, the federal dependent care tax credit may provide a greater benefit than the Dependent Care Flex Plan. You may be able to coordinate the federal dependent care tax credit with participation in the Dependent Care Flex Plan for expenses not reimbursed through the plan.
Who are eligible dependents for the Health Care FSA?
You can submit expenses for your spouse, dependent child(ren) or all who are:
  • age 26 or younger
  • over age 26 and developmentally disabled or physically handicapped, living with the participant or in an institution, unable to work, and depending primarily upon the participant for support
When can I enroll?
During your company's enrollment period each year.
Special enrollment periods for new hires and other employees who first become eligible during the coverage period.
When you have a qualifying event such as marriage, birth of a child or adoption of a child.

More..

When can I change my elections?
Once you enroll, your election will remain in effect for the entire plan year unless you have a qualifying event like marriage, birth or divorce. Election changes made because of a qualifying event must be consistent with the change. For example, you may increase your FSA contributions, not decrease if you have a baby.
How much money should I contribute?
Take into consideration last year's health-related and dependent care expenses as well as future medical and dental care costs that might not be covered under your medical plans. You may also want to consider any changes in your family status that might have an impact on health care and dependent care expenses. Due to IRS regulations, any money left in your FSAs after all claims have been processed for that plan year must be forfeited unless your company has adopted the "Carryover" provision. Please refer to your Summary Plan Description for Details.
When is an expense incurred?
An expense is incurred on the date that you receive the service or treatment, not the date you are billed or when payment is made.
How do I get reimbursed?
You must submit a claim form and attach your receipts. The receipts must provide the description, date and cost of the service as well as whom the service was for and the service provider. You can also have immediate access to your FSA funds by using your TRI-AD BenefitCard at the point of purchase.
How much time do I have to spend this year's FSA Funds?
Some employers allow a "grace period" of up to two-and-a-half months into the next plan year during which you can claim FSA expenses against your current year's account balance. You must be participating at the end of the plan year for the grace period to apply. Click here for details on the grace period.
How do I know how much money I have?
You have access to your account information 24 hours a day, seven days a week! You can access your personal account information by logging in using the Employee/Participant Login button on the top right of this page (a one-time registration is required) or you may call the Voice Response Unit (VRU) at 1-888-844-1372. If you use the VRU, you will need your Social Security Number and PIN number. In addition, each reimbursement you receive contains your account year-to-date information.
How do I receive reimbursement for orthodontia expenses in my Health Care FSA?
Reimbursement rules for orthodontia are a little different than for other eligible health care expenses. You can be reimbursed before services are provided if you submit proper documentation with your claim. Credit card slips, bank statements and canceled checks are not valid documentation.
When submitting a claim for orthodontia, keep the following in mind:
  • You have to be an active participant in the plan -- You must be actively employed and making contributions to the FSA (or participating through COBRA).
  • Services must be rendered -- The IRS requires that your payments be made specifically for a service/treatment in the same plan year. Payments for services you received in a previous plan year, or payments for services that won't take place until the following plan year are not reimbursable.
  • You can be reimbursed for lump sum payments OR for payment plans. You must pay only the payment amount shown on the contract and you generally can't change methods unless you get a new contract to submit with your claims showing the new contracted payment amount.
    • Lump sum payments -- Submit your documentation from the orthodontist showing the name of the person receiving the treatment, the beginning and ending dates of the treatment, the total contracted amount and the amount that was paid.
    • Payment plans -- Submit your documentation from the orthodontist showing the name of the person receiving the treatment, the beginning and ending dates of the treatment, the total contracted amount, the payment schedule (e.g. monthly) and the amount of your first payment. Submit a copy of the same documentation, showing each payment, with each claim for reimbursement.

If you make payments not specified on your contract (e.g., late payment fees, an extra amount to pay off the total early), your claim may be denied. Call TRI-AD for further guidance on obtaining the right supporting documentation for your orthodontia claims or click here for a summary of orthodontia reimbursement in your FSA.

Who can I call for help?
Customer service representatives are available Monday-Friday between the hours of 5:00 a.m. to 6:00 p.m. Pacific Standard Time. If you are in San Diego, please call 760-743-7555, outside the area, please call 1-888-844-1FSA(1372).
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