Term
| Dependant Care Account (DCA) |
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Definition
| A benefit accunt to be used for eliivle daycare or childcare expenses that are incurred for a member (EE) to work. |
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Term
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Definition
| A Transaction on a member's account that has not been substantiated yet. We are awaiting documentation. |
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Term
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Definition
| Timeframe in which a member can still submit claims to be reimbursed from their previous plan year, for services that were incurred during that plan year. |
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Term
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Definition
| This benefit account reimburses a participant for expenses incurred to transit to place of work including bus passes, metro tickets and ferry passes. (Public Transportation) |
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Term
| Explanation of Benefits (EOB) |
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Definition
| Statement from a memvers insurance company showing service rendered for a given month. |
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Term
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Definition
| When the total approved amount is not paid to a memver do to a valance due on their account, almost always do to an ineligible charge. |
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Term
| Limited Purpose Felexible Savings Account (LPFSA) |
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Definition
| To be used for eligible Vision and Dental expenses. Does not cover medical. |
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Term
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Definition
| Documentation showing a charge processed from a benefit account was for an eligible service. |
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Term
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Definition
| The last day a member can swipe their card and it draws from the previous years funds. |
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Term
| Insufficient Documentation |
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Definition
| A Member submits documentation to substantiate a charge. His documents have his provider's name, services rendered, the amount of the service, and his name. His transaction will be statused as ______. Because it was missing the Date of Service. |
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Term
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Definition
| This may be attached to an HRA to require the member to pay for a portion of their expenses out of pocket prior to being reimbursed from the HRA account. Reason may be because the HRA is funded by the Employer and they want the Employee to take some responsiblity for their health care by paying a portion. |
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Term
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Definition
| If after reviewing submitted substantiation documents a claims processor deems the transaction wss for a non- qualified expense it will be statused as ________. |
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Term
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Definition
| Allows either all of the remaining or a portion of the remaining funds in a member's benefit account to be added to the next year's balance. |
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Term
| Flexible Spending Account (FSA) |
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Definition
| A Benefit account to be used for eligible medical, dental and vision expenses. |
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Term
| Name the items that must be on submitted documentation to substantiate a charge? |
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Definition
Name of member
Name of Doctor
Date of Service
Service Rendered
Amount (Cost) of Service |
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Term
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Definition
| This benefit account reimburses a participant for expenses incurred to park near place of employment. |
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Term
| Our company processes how many health care dollars annually? |
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Definition
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Term
| Non Qualified expenses are subject to tax and _______? |
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Definition
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Term
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Definition
$1000
Additonal amount you are able to contribute if your are 55/+ years of age. |
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Term
| Return of Excess Contribution |
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Definition
| The act of an account holder removing funds from their HSA that have exceeded the IRS allowable limit. |
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Term
| 2016 Single Coverage Contribution Limit |
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Definition
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Term
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Definition
| Contributions to an HSA by sending in a personal check or making a direct deposit contribution through the web portal. |
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Term
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Definition
| Whaere an account that has the total amount of the employee's election deposited into their benefit account at the beginning of the plan year. |
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Term
| Health Savings Account (HSA) |
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Definition
| This benefit account allows for tax deferred dollars to be deposited into them to be used for eligible medical expenses. |
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Term
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Definition
| A Request for reimbursement from a benefit account. |
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Term
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Definition
| Expenses deemed medically necessary by the IRS under Section 213 (D), and eligible to be paid for using post tax dollars. |
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Term
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Definition
| Specifiying a portion to be removed from your paycheck prior to being taxed and deposited int an HSA. |
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Term
| Carded HRA (Health Reimbursement Account) |
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Definition
| This acccount will have a benefit card attached to the account which they will swipe as they would swipe their personal checking account debit card. Note there are also HRA's that do not have cards, this is the employer's choice. |
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Term
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Definition
| The act of an acccount holder repaying their HSA in the amount of a non qualified expense using post tax dollars. |
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Term
| 2016 Family Coverage Contribution Limit |
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Definition
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Term
| Health Reimbursement Account/Arrangement |
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Definition
| A benefit account in which the employer provides a set amount of funds to their employee which the employee can be reimbursed from for their medical expenses. |
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Term
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Definition
| A contribution performed prior to April 15th and counted towards the previous years IRS set contribution limit. |
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Term
| If after reviewing submitted substantiation documents a claims processor deems the transaction was for a non qualified expense, what status will it be placed in? |
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Definition
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Term
| The last period a member can swipe their card and it will draw from the previous year's funds is referred to as the: |
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Definition
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Term
| A member submits documentation to substantiate a charge. His documents have his provider's name, services rendered, dates of service and the amount of service along with his name. His transaction will have what status? |
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Definition
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Term
| HSA Holders Will Recieve 2 tax Documents Name them? |
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Definition
1099-SA Withdrawals (no later than Jan 31)
and
5498-SA Contributions (no later than May 31) |
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Term
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Definition
| Anyone as long as the employer offers it. |
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Term
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Definition
| Anyone as long as the employer offers it. |
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Term
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Definition
| Anyone as long as the employer offers it. |
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Term
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Definition
| Anyone as long as the employer offers it. |
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Term
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Definition
| Anyone as long as the employer offers it. |
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Term
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Definition
Employee with a taxable dependant,
If a child the dependant must be under the age of 13.
A dependant can also be court appointed making the employee the gardian.
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Term
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Definition
1. Must qualify by having a High Deductable Health Plan (HDHP)
2. Cannot be claimed under someone elses taxes
3. Not covered by supplemental insurance |
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Term
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Definition
| Pre Funded at the beginning of the year and paid back through payroll deductions. |
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Term
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Definition
| Through payroll deductions, can only use available funds. |
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Term
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Definition
| Payroll Deductions or Post Tax Contributions |
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Term
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Definition
| It depends on the employer, it could be funded by the employer at the beginning of the plan year or quarterly. The plan determines this. |
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Term
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Definition
| Through payroll deductions and you can only use what is available. |
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Term
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Definition
| It is prefunded and paid back through payroll deductions. |
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Term
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Definition
| It is funded through payroll deductions and you can only use what is available in the account. |
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Term
| What is eligible to be paid on an FSA? |
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Definition
| Medical, Dental and Vision |
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Term
| What is eligible to be paid on an DCA? |
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Definition
| Childcare not educational in nature. |
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Term
| What is eligible to be paid on an HSA? |
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Definition
| Medical expenses as in tax code 213 (D) |
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Term
| What is eligible to be paid on an HRA? |
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Definition
| What ever the employer wants to cover, it will be outlined in the plan documents. |
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Term
What is eligible to be paid on an TRN? |
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Definition
| Public transportation to and from work. (NOT GAS) |
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Term
| What is eligible to be paid on an LPFSA? |
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Definition
| Dental and Vision (Not Medical, as it would be covered by HRA) |
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Term
What is eligible to be paid on an PKG? |
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Definition
| Employee/members parking near work. |
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Term
| What is a LOMN stand for? |
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Definition
| Letter of Medical Necessity. |
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Term
What is a letter of medical neccesity used for? |
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Definition
| A letter written by a qualified medical professional stating that the purchase or procedure was medically necessary will make it covered under IRS 213 (D) and a qualified expense. |
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Term
| If you are 65 and on medicare can you have HSA? |
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Definition
| No because you can't have supplemental insurance such as medicare. You can use funds you already have in your account. |
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Term
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Definition
| It is a worksheet you fill out to determing qualified and non qualified expenses. It is completed as part of your taxes. |
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Term
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Definition
| Yes, as long as it stays in an HSA account there are not tax consequences. If you separate from your employer you can put it into a retail HSA. |
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Term
| When moving your HSA money, how is it reccommended you move it. What method? |
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Definition
| It is best to move as a trustee to trustee transfer. If you choose to rollover the funds yourself it must be done in 60 days and you are responsible for documentation of the rollover to the IRS. |
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Term
| Explain movement of your HRA into a retirement vehicle such as an IRA. |
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Definition
You can move your HSA to an IRA, but it is a once in a lifetime move and it must not exceed allowable limits as a retirement contribution.
IRA 2016 Contribution Limit
$5500. under 50
$6500 over 50 |
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Term
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Definition
| You no longer work for the company you have HSA with. You can leave it there but it can't have any activity, you can move it to a Retail HSA which is Reassociation. |
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Term
| When an employee is no longer employed what term is best to use? |
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Definition
| Separated from the company. |
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Term
| If you are over 55 how much can you contribute to your HSA? |
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Definition
Single $4350
Married $7650 |
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Term
Who owns the money in an HRA? |
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Definition
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Term
| What is a Non Carded HRA? |
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Definition
| The member has no benefit card and must pay out of pocket and submit claim for reinbursement. |
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Term
How can you submit a claim on your HRA? |
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Definition
1. Online
2. Mailed in with claim form
3. Faxed in with claim form
4. Emailed with a claim form
5. Using Mobile App |
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Term
| How quickly are claims processed? |
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Definition
| Within 3 business days of receipt of claim. |
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Term
| How can you submit a claim during run out. |
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Definition
During Runout:
1. You cannot use your card but you can submit a claim.
2. During runout period it pulls from the previous years funds.
3. Service date would be from the previous plan year. |
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Term
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Definition
1. You use the card in the new plan year and it pulls from the previous plan year funds.
2. During the grace period it can be from any service date, previous year or current year during the grace.
3. Note funds will pull from previous year 1st, before it attacks the funds from current plan year.
4. Employer can opt for this. |
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Term
| HRA Funds, how do they work from year to year? |
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Definition
| Typically they are use it or lose it, but they are employer funds so the employer can decide to roll to the next year if they want to. It will be layed out in the plan documents. |
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Term
| Explain Reocurring Charges. |
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Definition
Frequent medical charges, you would need to submit a Payment Contract (Example: Braces) this would allow you to not have to submit for each claim.
Need to be: Same dollar amount, Same Provider, Same Merchant Catagory Code. |
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Term
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Definition
| Provider was paid and not further action is needed. |
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Term
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Definition
| Provider was not paid and not further action is needed. |
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Term
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Definition
| Needs substantiation for more information to adjudicate. Provider has been paid. |
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Term
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Definition
| Requested documentation, you send docs and we can tell definatively it was not able to be paid after review of the account. Payback or provide further documentation to prove the charge , maybe a LOMN. |
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Term
Status Code: Insufficient Documentation? |
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Definition
| This has not been decided yet. Read notes to find out what is needed. Something is normally missing and qualified/unqualified cannot yet be decided. |
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Term
Status Code: Ineligible Transactions? |
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Definition
| Create Balance Due. After seeing everything we ar not able to pay. You would need to pay back with Pre Tax Dollars. It was not an allowable claim, you can also OFF SET with another claim. |
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Term
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Definition
| Employee/Member thinks we communicate with insurance company about previous charges. Since many HRA's have deductable we have no way of knowing what expenses you have incurred unless you send in record of medical expenses. Member must communicate expenses. |
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Term
| If reimbursement for qualified expense is coming by check how long will it take? |
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Definition
If everything is in good order, It will take 7-10 business days from the date it is approved to arrive to the member.
It also take 3 business days to process once it is received. |
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Term
| What is the dependant care limit $? |
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Definition
Typically $5000.00 per household
$2500 pp if married filing separately |
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Term
| What is the TRN and PKG Limits? |
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Definition
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Term
| What is the contribution limit for FSA and LPSA? |
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Definition
| $2550.00 for each of them |
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Term
| When can you set your election for FSA, HSA and LPSA |
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Definition
| Only during open enrollment or if you have an IRS pre qualifying event. |
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Term
| List FSA Qualifing Life Events? |
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Definition
Member changes legal name/status, Change of employment, Change of tax dependants, Death of spouse or Dependant, Change of eligibility child reaches 13 no longer can use DCA, Significant Change in the rate charge DCFSA.
Note these are handled by the Plan. |
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Term
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Definition
| If funs remain in the FSA at the end of the plan year the employer may offer a rollover option. Irs guidelines state it can be up to $500.00 rolled into the new calendar year. This is at the employers discretion. If you leave the company you forfeit the funds. Must be used for Benefit related expenses, based on IRS guidelines. |
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Term
| What is needed to submit a DCA Claim? |
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Definition
Dependants Name
Providers Name
From-Through Date of Service
Amount of Charge
TIN/EIN of Daycare provider or
Individual Provider SSN
Note: Cannot be Spouse or Dependant Caregiver |
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Term
| TRN/PKG Documentation Requirements? |
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Definition
Provider, Amount, Date Paid
Not 100% necessary, Looking at Merchant Catagory Code may provide all the necessary information. Consult with supervisor if you get push back. |
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Term
| If PKG or TRN charges are denied what happens? |
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Definition
| Create a balance, send in check or off set transaction. |
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Term
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Definition
| Applies to FSA and it is a Spend Down Feature. It allows member to spend funds till year end or or plan end date. |
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