Flex Card Frequently Asked Questions

I received a letter or e-mail from myCafeteriaPlan. What does this mean? A receipt request is a letter or e-mail notice that supporting documentation is needed to verify transac-tions that have occurred. These notices are important and you may receive several notifications until the matter is resolved. Automatically approved transactions will not be included in these notices.

Will I be asked to document all expenses paid with the card? Not necessarily. Here’s how it works: Use the card at Inventory Information Approval System (IIAS) ap-proved merchants - all eligible items will automatically be approved.

When using the card at your Medical Providers the IRS allows for benefit co-pay amounts to be automatically approved. Any amounts that are not a co-pay will require documentation.

The Flex Card can only be used to pay for ser-vices provided in the current plan year.

Why do I need to provide a copy of my receipt?As an IRS regulated benefit, use of your benefit dollars is limited to certain expenses. When you use your Flex Card and the amount does not match a co-pay or is not used at a merchant that automatically ap-proves Flex Card transactions, a follow-up receipt may be requested to confirm that the expense is eligible.

When the Flex Card is used as payment, myCafeteriaPlan only receives basic information similar to the information you see on a bank statement. This information is limited to the date the card was used, the amount charged and the provider name.

What information should be on my receipt?Because your FSA is a pre-tax benefit, the IRS requires specific information to be listed on the receipt to determine if the claim is eligible. Below is an example of a good receipt.

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Example of a Good Receipt

Provider Name and Address

Patient/Dependent Name

Description of Service

Date of Service

Amount Charged

Did You Know?Some practitioners may provide services that are not considered eligible by the IRS for FSA plans. Examples include teeth whitening at the den-tist office or cosmetic procedures at the dermatologist.

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DISCLAIMER: Every effort has been made to present this information accurately, however, this is just a summary overview. An overview means that details, explanations and qualifiers are left out. This information is intended only to provide general guidance and you should not rely on it as a complete explanation of this topic. OTC rules and guidelines are subject to change. This is not a legal docu-ment.

BABY/CHILD TO AGE 13 • Breast Pumps • Lactation Consultant* • Lead-Based Paint Removal • Nursing Supplies • Special Formula* • Tuition: Special School/Teacher for Dis-ability or Learning Disability* • Well Baby /Well Child Care

DENTAL • Dental X-Rays • Dentures and Bridges • Exams and Teeth Cleaning • Extractions and Fillings • Oral Surgery • Orthodontia • Periodontal Service

EYES • Eye Exams • Eyeglasses and Contact Lenses • Laser Eye Surgeries • Prescription Sunglasses • Radial Keratotomy

HEARING • Hearing Aids and Batteries • Hearing Exams

LAB EXAMS/TESTS • Blood Tests and Metabolism Tests • Body Scans • Cardiograms • Laboratory Fees • X-Rays

MEDICAL EQUIPMENT/SUPPLIES • Air Purification Equipment* • Arches and Orthotic Inserts • Contraceptive Devices • Crutches, Walkers, Wheel Chairs • Exercise Equipment* • Hospital Beds* • Medic Alert Bracelet or Necklace • Nebulizers • Orthopedic Shoes* • Oxygen* • Prosthetics • Syringes • Wigs*

MEDICAL PROCEDURES/SERVICES • Acupuncture • Alcohol and Drug/Substance Abuse (in-patient treatment and outpatient care) • Ambulance • Fertility Enhancement and Treatment • Hair Loss Treatment* • Hospital Services • Immunization • In Vitro Fertilization • Physical Examination (not employ-ment-related) • Service Animals • Sterilization/Sterilization Reversal • Transplants (including organ donor)

MEDICATIONS • Insulin • Prescription Drugs

OBSTETRICS • Lamaze Class • OB/GYN Exams • OB/GYN Prepaid Maternity Fees (reim-bursable after date of birth) • Pre- and Postnatal Treatments

PRACTITIONERS • Allergist • Chiropractor • Christian Science Practitioner* • Dermatologist • Homeopath • Optometrist • Osteopath • Physician • Psychiatrist or Psychologist

THERAPY • Alcohol and Drug Addiction • Counseling (not marital or career) • Hypnosis • Occupational • Physical • Smoking Cessation Programs* • Speech • Weight Loss Programs*

The following list is not meant to be an all-inclusive list of potentially eligible FSA as other expenses not specifically mentioned may also qualify. Also, expenses marked with an asterisk (*) are “potentially eligible expenses” that require a Note of Medical Necessity from your health care provider to qualify for reimbursement. Each plan is different; for additional information specific to your plan, check your Summary Plan Document or contact myCafeteriaPlan.

FSA Eligible Expenses

Eligible Over-the-Counter ItemsThe following is a high-level list of Over-the-Counter (OTC) items that clearly are not medicine or drugs and may be eligible for purchase with FSA dollars depending on your plan.

Baby Electrolytes • Pedialyte, Enfalyte

Denture Adhesives, Repair, and Cleansers

• PoliGrip, Benzodent, Efferdent

Diabetes Testing and Aids • Insulin, Ascencia, One Touch, Diabetic Tussin, insulin syringes; glucose prod-ucts

Diagnostic Products • Thermometers, blood pressure moni-tors, cholesterol testing

Elastics/Athletic Treatments • ACE, Futuro, elastic bandages, braces, hot/cold therapy, orthopedic supports, rib belts

Eye Care • Contact lens care solution

Family Planning • Pregnancy and ovulation kits

First Aid Dressings and Supplies • Band Aid, 3M Nexcare, non-sport tapes

Hearing Aid/Medical Batteries

Incontinence Products • Attends, Depends, GoodNites for juve-nile incontinence

Reading Glasses and Maintenance Accessories

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