Many flex plan participants have asked this question. The good news is that many of your Flex Card transactions will be auto-substantiated (automatically approved) and will not require you to submit documentation. There are two scenarios in which auto-substantiation occurs:
IIAS Retail Locations
IRS regulations say you do not need to send documentation when you use your Flex Card to pay for transactions at retail locations with an Inventory Information Approval System (IIAS), which only allows you to use your Flex Card for eligible items at these retail locations. Most major chain retail merchants and many local retail merchants have an IIAS in place.
Another scenario in which no documentation would be required is if you use your Flex Card at a medical provider for a copayment, assuming that (1) you are enrolled in your employer's group health plan; and (2) your employer has provided ProBenefits with the copay amounts for its group health plan.
The IRS requires, however, that you submit documentation for all Flex Card transactions that fall outside of these auto-substantiation standards.
Transactions that may require documentation when you use your Flex Card to pay a medical service provider:
- You swipe your card for an amount that does not match the appropriate copay amount. For example, your specialist copay amount is $50, but you pay $73 for your copay plus a balance from a previous visit; or your spouse is not on your group health plan, and uses the Flex Card to pay a different copay amount.
- You are not a participant in your employer's group health plan, so the copay amount you swipe is not linked to the plan.
- You use your Flex Card at the dentist or a vision center, since most insurance plans do not have copays for these providers.
Transactions that may require documentation when you use your card at a retail merchant:
- Your plan may allow card swipes at certain merchants other than those with an IIAS; if so, these swipes will require documentation. Check with ProBenefits for your plan specifics.
- Very occasionally, an IIAS merchant's system doesn’t provide all the information we need for autosubstantiation, so documentation may be required.
Frequently Asked Questions
If the card is used at a medical service provider, shouldn't that be approved no matter what?
While your card transaction must be from a valid provider of medical services (the card cannot be used at other locations), many medical, dental and vision service providers can also provide services which are ineligible for reimbursement, including:
- Teeth whitening at the dentist
- Cosmetic services provided by a doctor
- Non-prescription sunglasses at the optic shop
- Vitamins and supplements at the chiropractor
What else might cause me to have to submit documentation?
Even if charges are for eligible services, they may not fulfill all the requirements for eligibility. For example, if the Flex Card is used to pay for services performed in a prior plan year, it may be an ineligible expenditure if:
- The participant's election is depleted for the prior year
- The participant did not have an election during the prior year
- It is after the deadline for filing claims on the prior year's account
Why does the IRS have this requirement?
The documentation requirement helps keep your plan compliant with IRS regulations by making sure ineligible purchases made by accident don’t slip through. Remember to keep all your documentation, even if it is not requested by ProBenefits, because the IRS may require it if you are personally audited.
If I am asked to send documentation for a Flex Card transaction, what do I send?
The best form of documentation to send is the Explanation of Benefits (EOB) from the insurance company for medical service providers covered by your insurance, including primary care doctors, specialists and dentists if you have dental insurance. For medical providers not covered by insurance, which often include vision service providers, make sure you have a clear receipt showing the date of service, type of service provided, provider name, and the amount of the expense.
Have more questions about submitting Flex Card documentation?