IRS SUBSTANTIATION REQUIREMENTS

IRS regulations govern the eligibility of claims. As your Flex Administrator, BASIC helps ensure that you and your employer stay within those regulations. As an FSA Administrator we are required to receive specific documentation showing that your purchase is an eligible expense according to the IRS regulations.

• NECESSARY DOCUMENTATION
  
• AUTO ADJUDICATION OF CO-PAYS WITH THE BASIC FLEX/HRA DEBIT CARD
• HOW TO FILL OUT YOUR REIMBURSEMENT FORM

NECESSARY DOCUMENTATION

• Best
  The best form of documentation for medical, dental & vision expenses is an EOB (Explanation of Benefits) from your insurance carrier.
• Itemized statement
  An itemized statement is also acceptable but needs to include date of service, service provided, provider's name, address & charge for the service. This is true for verifications as well as reimbursement requests.
• Prescriptions
  For prescriptions, please provide a cash register receipt that lists RX next to the item number and/or RX tag. Pharmacy print outs are also acceptable.
• Vision
  Send detailed vision bills which include date of service, service provided, provider's name, address & service charge. A single receipt may include the cost of a warranty, which can not be reimbursed.
• Orthodontics
  Send detailed receipts or payment coupons which indicate orthodontic treatment and also include; date of service, provider name and description of service.
• Massage therapy and weight loss programs
  For massage therapy and weight loss programs; please submit a copy of the physician's statement of medical necessity, which includes length and frequency of treatment, with every reimbursement request. Obtain a new physician's statement of medical necessity at the beginning of each plan year.
• Letter of medical necessity
  A letter of medical necessity needs to include a diagnosis, duration of treatment and description of treatment plan.
• Faxing
  Circle items on receipts or bills with a pen. Please don't use a highlighter; they often fax too dark to read. If the original is light please make a darker copy prior to faxing.

AUTO ADJUDICATION OF CO-PAYS WITH THE BASIC FLEX/HRA DEBIT CARD

In cases where the total transaction exactly matches an even multiple of a single co-pay (up to five times) verification is not necessary. While this is a great time saving feature there are several things to keep in mind.

1. The employer that offers the FSA needs to provide BASIC with co-pay amounts in order for us to be able to auto adjudicate. Please verify your co-pays with a BASIC Flex Customer Service Representative.

2. While this seems straight forward there a couple of things that can be tricky. Please read the examples below for better clarification.

• Flex and health insurance offered at different companies
  Mary and Bill are married. Their health insurance is provided by Bill's employer ABC. Mary signed up for BASIC Flex at her employer ZCorp. Mary will need to verify all BASIC Flex debit card transactions. The reason for this is BASIC will have ZCorp's co-pays on file connected with Mary's Flex Card; NOT Bill's employer ABC co-pays, which is where their insurance is through.
  • Exactly matching a single co-pay
    Jill's insurance has several different co-pays. Prescription: $7 for generic, $18 for name brand. Office visits: $20 for in network, $30 for out of network. Jill will NOT need to send in verification if she purchases 3 generic prescriptions for a total transaction of $21, because $21 exactly matches an even multiple of a single co-pay. However, Jill will NEED to send in verification if she purchases 1 generic prescription and 1 name brand prescription, because $25 does NOT match an even multiple of a single co-pay.
• You should always keep your receipts for the duration of your plan year. If you are ever unsure if verification is needed, it is better to be on the safe side and submit verification.

HOW TO FILL OUT YOUR REIMBURSEMENT FORM (Medical Reimbursement)

1. List the company that the employee works for at the top of the form
2. List the participants first & last name in appropriate boxes
3. List the last four digits of your social security number
4. List all requested claims on separate lines, add a separate form if necessary or separate itemized sheet in excel, word, or lined paper
5. List the amount that you are requesting reimbursement per receipt on each line
6. You do not need to separate your claims between individuals in your family

HOW TO FILL OUT YOUR REIMBURSEMENT FORM (Dependent Care)

1. List the company that the employee works for at the top of the form
2. List the participants first & last name in appropriate boxes
3. List the last four digits of your social security number
4. You do not need to list your family members medical claims under Day Care expenses / Dependent care expenses
5. The signature on the bottom of the form should only be signed by the day care provider.