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Accounts

Flex-Ed: What happens if your FSA claim is denied?

It's embarrassing when your credit card is declined because it feels like everyone—the people in line and the cashier—is looking at you. The good news is that you typically know how to handle it: call the bank, try a different card, or check your balance.

But what happens if your FSA claim is declined? It often feels similar, but the next steps can be confusing. Here's everything you need to know if your FSA card is denied.

Don't panic

Regardless of why your card was denied, there's no need to be embarrassed. It doesn't mean you've done anything wrong and there's a good chance it's not even your fault. There are a lot of reasons your FSA claim might be denied and most have an easy fix. The first step is to figure out whether or not your card has been activated.

Forgetting to activate your card is a common oversight with a simple solution: call your card administrator or explore your company's benefits website to learn how to activate your card.

Double check your funds

Let's be honest: sometimes it's hard to keep track of everything and that includes your FSA card balance. If your FSA claim is denied, it might be because you had insufficient funds in your account or that the price of the item you tried to purchase is higher than your balance. Be sure to check your balance before you use your card again.

Make sure you're using an approved merchant

FSA cards come with a lot of specific rules and one of the primary rules is that you can only use your account to buy FSA-eligible items. Various restrictions are put on the card to ensure that you use the funds correctly, including limitations based on merchant type, limitations based on merchant systems and limitations based on merchant inventory, to name a few.

The easiest way to ensure that your items are eligible is by shopping at a store that exclusively sells FSA-eligible items. It takes the guesswork out of shopping and decreases the chances that your FSA card will be declined.

But, for the most part, your FSA card should work where it makes sense; at locations such as local pharmacies and drug stores, vision centers, doctor and dental offices, etc. But if you try to use your card at an ice cream parlor or an auto parts store, even if that ice cream parlor happens to sell FSA-eligible bandages, chances are your card won't work.

If you have questions about whether or not a specific merchant will allow your FSA card, you can contact your FSA administrator to find out.

Confirm with your employer that the item is eligible

Here's the deal: the IRS determines which items are FSA-eligible. However, employers can set their own eligibility rules as long as they are adhering to the IRS guidelines. In other words, it's important to check in with your FSA administrator and confirm that the item you tried to buy is FSA-eligible.

If your FSA card was declined but you decided to buy the item with a different card, then it's still a good idea to try and get reimbursed through your FSA. If you bought the item through FSAStore.com and the item was allowed under your plan guidelines, we guarantee that the item is FSA-eligible, so be sure to save your receipt and submit for reimbursement.

But remember: items with a red check mark are always FSA-eligible, while products marked with a BLUE "Rx" require a prescription from your doctor in order to be eligible.

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New to FSAs? Need a refresher course in all things flex spending? Our weekly Flex-Ed column gives you a weekly dose of FSA Living 101, offering tips for making the most of your tax-free funds. Look for it every Thursday, exclusively on the FSAstore.com Learning Center.

Basics

Guide to using your FSA card

FSA cards are pretty common these days – almost every FSA provider gives you one to help using your funds (and tracking your spending) easier. But if you're new to FSAs (or at least new to these cards) you probably have some questions about how they work, where they can be used, what they're NOT for, etc. etc.

Well, if you haven't figured it out by now, we love making guides for these types of things.

A big-picture look at the humble-but-awesome FSA card

Flex spending cards are essentially the same as debit cards but used only to cover eligible medical expenses. In some cases, FSA holders who wish to access their funds are required to pay an out-of-pocket expense, and then submit receipts to their benefits administrator. Employees get reimbursed once the paperwork is submitted for eligible expenses.

FSA cards make the reimbursement process much easier by automatically withdrawing funds from the debit card. However, if an FSA holder opts to make a purchase with his/her card for a product or service that is a non-health care merchant, this merchant has to support an inventory information approval system (IIAS).

We could go into a lot of details about these systems, but there's no need to bore you with jargon. The key takeaway about these systems is: They verify eligibility so you're not hit with a surprise denial. When you use your card, the computers immediately recognize eligible vs. non-eligible expenses, so you can shop accordingly, and play by the rules!

That's basically it. BUT, if you ventured here wondering about the difference between FSA and HSA cards, guess what? They function in the exact same ways. And the information below will help you understand how to handle your card.

Ways to check the balance on your FSA card

  • Log into patient portal
  • Use the provider app
  • Call TPA at the number provided
  • Some retailers might also have balance information available at the bottom of their receipts.

Waiting to get reimbursed for an FSA-eligible item the traditional way can be a little mind-numbing—filing paperwork with your FSA administrator, waiting for approval and paying out of pocket in the meantime. Luckily, the FSA card streamlines the process.

The reason? Your FSA card is linked directly to your FSA. But here's the deal, FSA cards are slightly different than standard debit cards and come with their own set of rules. Here's what you'll want to keep in mind.

You can't withdraw money from an ATM

A significant difference between the FSA card and a standard debit card is that you can't grab cash from an ATM using your FSA funds. No - this is strictly for eligible health care expenses.

The easiest way to be sure your purchases are eligible is to shop at a store that exclusively sells FSA-eligible items (hint, you're already here). It removes the guesswork and allows you to focus on getting the items you need without having to file for reimbursement.

You can't use it in every store

It might sound obvious, but it's important to note that you can't use your FSA card at just "any" store, unless the purchases are eligible for FSA reimbursement.

In order to be able to use your FSA card, either the merchant category must be approved by the FSA administrator or card issuer, or the merchant must be specifically approved or the merchant must have a system in place to allow the use of the card on FSA-eligible items.

What to do if your card is lost

Having your payment information or identity stolen is about as scary and uncomfortable as it gets. And having it happen to your FSA is no different. But it's important to not panic.

We know money is money, but these accounts are as safe as any other banking you might do -- as long as you're careful and have good records of your purchases (yes, even with the card) all will turn out right.

What happens if I lose my FSA card or get hacked?

If a fraudulent purchase has been made with your FSA, you'll need to notify your administrator immediately so that they can open an investigation. Once the investigation is completed, your funds will be reimbursed into your account.

Keep in mind, your account will likely be shut off until the investigation is complete, and a new card will have to be sent to you. Keep this in mind when making additional purchases, so you can still use the traditional reimbursement approach to access the tax-free funds.

How to keep your FSA safe

While there isn't a 100% guaranteed method to preventing fraud, there are steps you can take to help keep your FSA safe. You'll want to treat your FSA card (and all of your account info, for that matter) with the same care and precautions that you would give any debit or credit card.

An FSA card doesn't have nearly as many places where it can be used, it's still a source of funds that people can purchase items they need. And because of that, it's important to treat FSA fraud like any form of card theft.

First off, it's pretty clear you should keep your physical card in a safe place where others can't easily access it. You should sign the back of your card as soon as you get it, and never store a PIN with the card.

Also, don't give your card number to anyone you don't trust. We could do another guide of all the places NOT to give your card number. But for now, one place you definitely shouldn't is over the phone, unless you're the one who made the call to a business or medical office, so you know the people you're speaking to are legit.

If you do give your card number out over the phone, make sure you're speaking with a reputable outlet, and are in a private place where others can't overhear the information.

(And never, ever provide your card number through email. No reputable store would ever ask you to do this. Shop smart, everyone!)

If you're making payments online, be sure to use a secure connection. Never make payments or enter your info over a public Wi-Fi connection. This makes you vulnerable to hackers who can easily access your account. Only make purchases from merchants that you trust who have a secure website.

Your FSA plan administrator is your friend

This all may seem obvious … but just for peace-of-mind and a quick resolution to any problems you might have, reach out to your plan administrator, to see their policies on processes, proper card use, etc. And always keep a copy of your confirmation for your records.

They can probably help you better organize and protect documents and receipts that may contain sensitive account information. And they can help keep your contact information up-to-date so no one else can try to access your account using older information.

What to do if your FSA card is declined

It's embarrassing when your credit card is declined because it feels like everyone in the store is looking at you. The good news is that you typically know how to handle it: call the bank, try a different card, or check your balance.

But what happens if your FSA claim is declined? It often feels similar, but the next steps can be confusing. Here's what you should know.

Don't panic

Regardless of why your card was denied, there's no need to be embarrassed. It doesn't mean you've done anything wrong and there's a good chance it's not even your fault. There are a lot of reasons an FSA claim might be denied -- and most have an easy fix. The first step is to figure out whether or not your card has been activated.

No, we're not kidding. Forgetting to activate your card is a common oversight with a simple solution: call your administrator or explore your company's benefits website to learn how to activate your card.

Double check your funds

Let's be honest: sometimes it's hard to keep track of everything and that includes your FSA card balance. If your FSA claim is denied, it might be because you had insufficient funds in your account or that the price of the item you tried to purchase is higher than your balance. Be sure to check your balance before you use your card again.

Make sure the merchant accepts FSA cards

For the most part, your FSA card should work where it makes sense; at locations like pharmacies, vision centers, doctor and dentist offices, etc. But if you try to use your card at a restaurant or bike shop, even if that bike shop happens to sell FSA-eligible bandages, chances are your card won't work.

If you have questions about whether or not a specific merchant will allow your FSA card, you can contact your FSA administrator to find out.

(But let's be honest, did you really think a restaurant was going to accept pre-tax health care funds for that lobster roll?)

The easiest way to ensure that your items or services are eligible is by checking out our comprehensive Eligibility List, and by shopping at a store that exclusively sells FSA-eligible items. It takes the guesswork out of shopping and decreases the chances that your FSA card will be declined.

Confirm with your employer that the item is FSA-eligible

The IRS determines which items are FSA-eligible. But employers can set their own eligibility rules as long as they're sticking to the IRS guidelines. In other words, it's important to check in with your FSA administrator and confirm that the item you tried to buy is FSA-eligible.

If your FSA card was declined but you decided to buy the item with a different card, then it's still a good idea to try and get reimbursed through traditional means. If you bought the item through FSAstore.com and the item was allowed under your plan guidelines, we guarantee that the item is FSA-eligible, so be sure to save your receipt and submit for reimbursement.

But remember: items on FSAstore.com that are marked with a red checkmark are always FSA-eligible, while products marked with a BLUE "Rx" require a prescription from your doctor in order to be eligible.

Other helpful FSA card tips

You should still save your receipts

Even though you won't need to file your receipts for reimbursement after every purchase, you'll still need to save your receipts. The IRS requires all FSA purchases be backed up with proof, so if your employer gets audited, you'll have to show itemized documentation of your FSA card purchases. Your administrator will also require you to submit receipts on select FSA card purchases.

In nearly every situation, the card will be accepted and processed without worry. But there's no better way to fight off "unpleasant surprises" than by keeping good records. You should always keep paperwork for charges, not just in the event of a denied charge. Depending on where you use the card, you may need to submit a receipt or documentation even if it was approved.

Why? Because if your benefits administrator denies an FSA card charge, having this paperwork handy to verify eligibility will save you time and hassle down the line.

Pro Tip: Use electronic receipts whenever possible. Just create a file in your inbox and simply move your receipts there throughout the year. It's a painless way to ensure you're following the rules.

You can still file manually

By now, you've probably figured out that an FSA card makes life simpler, but like we mentioned above, you don't have to use it. If there's ever a time when you forget it at home or are working with a medical provider that doesn't accept it, then don't worry. You can still file for reimbursement the old-fashioned way and submit receipts to your FSA administrator.

Accounts

Am I able to use my FSA card to purchase items at Walgreens, CVS or any other type of drugstores?

As long as you're using the card to purchase eligible items then most likely. However not every pharmacy is able to process FSA card transactions, so in some cases you won't be able to find out until you try to make a purchase or unless you check in advance with your FSA administrator. At FSAstore.com, we accept all FSA cards and all major credit/debit cards, so you can rest assured that your purchase of an FSA eligible product will be automatically approved.

Accounts

September FSA Mailbag! Recapping your best Learning Center questions

Each month, we receive hundreds of great questions from our customers about everything relating to FSAs in ourFSA Learning Center. This past August, we received a bunch of fantastic questions relating to FSA product eligibility, deadlines and more, that could help you see your flexible healthcare account in a new way.

If you have a question of your own, feel free to drop by and ask a question and we'll respond ASAP!

"Who is considered a dependent on my FSA?"

An FSA dependent can include the account holder's spouse, a dependent who you claim on your tax return or your adult children up to the age of 26.

"Can I use my FSA card for someone else?"

FSA funds can only be used by the account holder, his/her spouse and qualified dependents that are named on the account. To determine if someone is a qualified dependent, contact your FSA Third Party Administrator, whose information can typically be found on the back of an FSA debit-card or by contacting your HR department.

"Can I use my FSA card to rent mobility equipment, like a scooter?"

Even in the case of equipment rentals as opposed to a full purchase, a scooter rental is a qualified expense. However, this is only the case if your mobility is impaired because of an illness, injury, or other physical condition.

"I would like to order contacts - I have money in my FSA - do I have to pay out of pocket first or can it come out immediately from my account?"

If you visit our Optical Store, you can make a purchase directly with your FSA card. You can also pay with a credit/debit card if you so choose at our store or others, but then you will have to submit a claim for reimbursement with your benefits administrator.

"Does my FSA plan have a "carry over" option?"

Plans can allow one or neither of two options that can provide relief for FSA users. The first is a $500 rollover which allows FSA users to move up to $500 of their current plan year balance into next year's plan year account, sometimes called a "carry over." The other option is a 2.5 month grace period to give account holders more time to spend down their remaining FSA funds. To find out if either of these regulations are in place with your account, contact your benefits administrator whose information can be found on the back of your FSA card.

"Can I use my FSA to pay for exercise programs?"

FSAs can only be used to cover weight loss expenses if the weight gain is tied to a specific medical condition or if weight loss is medically required for a specified condition. Gym memberships, exercise equipment and other products/services that aid in weight loss require a Letter of Medical Necessity (LMN) from a physician that outlines how the product/service will be used to alleviate the condition.

To maximize the potential of your FSA funds with more than 4,000 FSA-eligible products, shop at FSAstore.com! Support your family's wellness year-round and get the most out of your flex dollars!

Basics

What you should know about HR 1270

If you've ever purchased over-the-counter (OTC) medicines with an FSA, you know that in order to buy these items with an FSA card or be reimbursed for a claim, you will need a prescription from a physician for these products. After the Patient Protection and Affordable Care Act (PPACA) (also commonly referred to as Obamacare) went into effect January 1, 2011, new restrictions were put into place regarding the purchase of over-the-counter (OTC) medicines with consumer-directed health accounts like FSAs and HSAs. This OTC Rx provision is a totally new restriction on account holders which requires them to submit a prescription from a physician to purchase OTC medicines with a consumer-directed healthcare account.

But while the provision may have had honorable intent in reducing drug "stockpiling", it has instead passed a heavy burden onto FSA/HSA account holders. As such, Congress has introduced The Restoring Access to Medication Act of 2015, also known as HR 1270, to restore the ability of plan participants to use the funds in their HSA, FSA, HRA or Archer MSA to purchase over-the-counter medications.

Does HR 1270 have a chance of passing?

As a result of the OTC provision, doctors are now saddled with the task of writing otherwise unnecessary prescriptions for medications to fight the common cold, flu or allergies. This has lead to inevitable increased wait times in doctor's offices, greater costs in time money for consumers and strained physician-patient relationships. Patients are forced to reach out to physicians to purchase EVERY over-the-counter product with a medicated ingredient, such as pain relievers, allergy medicines and more.

HR 1270 passed in the House of Representatives on July 6, 2016 and goes to the Senate next. The bill would remove the most difficult restrictions involving the purchase of OTC medications, but it only has a chance of passing with consistent public pressure.

As of January 10, 2017, HR 1270 has been re-introduced to the 115th Congress as HR 394, a nearly identical version of the bill that has bipartisan support and a real chance of passing in the coming year. Be sure to check back at FSAstore.com and on our social media channels for continued updates around the bill's progress and hopefully the future repeal of the OTC Rx provision.