Human Resources - Flexible Spending Account Card for Classified Staff

The collective bargaining agreement negotiated in September 2018 states that represented employees who make $50,004 or less per year (as of November 1, 2019) will receive a Medical FSA contribution of $250 in January 2020.

This contribution is an employer-paid benefit; it will not come out of your paycheck. If it is determined on November 1 that you will be a recipient, you will receive the $250 automatically from your employer. No action is required on your part.

Here’s how you’ll receive this benefit:

• If you do not enroll in a Medical FSA for 2020, Navia Benefit Solutions will open an account in your name and send you a welcome letter with a debit card loaded with $250. Use the debit card for eligible health care expenses by March 15, 2021. If you do not want the funds, you do not have to spend them. They will be forfeited.
• If you enroll in a Medical FSA for 2020, the $250 contribution will be added to your account with Navia Benefit Solutions in January 2020.

You will not receive this benefit if you enroll in a consumer-directed health plan (CDHP) with a health savings account (HSA) for 2020. This limitation is an Internal Revenue Service rule. You will also forfeit this $250 benefit if you waive PEBB medical coverage for 2020, unless you waive to enroll as a dependent on someone else’s PEBB medical plan (that is not a CDHP). If you cannot receive the $250 for these reasons, the collective bargaining agreement does not allow the $250 to be distributed or used in any other way. You will forfeit this benefit.

The Medical FSA covers health care expenses incurred during the coverage period for you, your spouse, or your qualified dependents, even if they are not enrolled in your PEBB medical or dental plan. You may also claim certain expenses for a child for whom you don’t get the tax exemption due to a divorce decree, as long as one parent claims the child as a dependent. The tax exemption may switch from year to year between parents. As long as one parent receives the tax exemption, the medical or dental expenses you pay on expenses you pay on behalf of the child may qualify for the Medical FSA reimbursement.

Below is a list of common expenses that may be eligible for reimbursement. Not all eligible items are on this list. For a complete list, visit the Navia Benefit Solutions website or call Navia Benefits Solutions at 1-800-669-3539. Items marked with an asterisk (*) are over-the-counter (OTC) medicines or drugs that require a prescription for reimbursement.

Generally, yes, as long as they are prescribed by a physician and are legal under federal and state laws. However, prescriptions that are purchased solely for cosmetic purposes and that don’t treat an existing medical condition do not qualify.

As of January 1, 2011, many OTC medicines or drugs require a prescription for reimbursement. If the OTC medicine or drug contains an active ingredient, then you must have a doctor’s prescription in order to be reimbursed for the expense. You can ask the doctor to complete the Letter of Medical Necessity. See below for details.

Certain expenses are not reimbursable under a Medical FSA unless a licensed health care practitioner states in writing to Navia Benefit Solutions that the service or product is medically necessary. Navia Benefit Solutions will need a Letter of Medical Necessity (LMN) for the items below before they can be reimbursed. Not all items requiring an LMN are on this list. For a complete list, and to download a printable copy of the LMN, visit the Navia Benefit Solutions website or call Navia Benefit Solutions at 1-800-669-3539.

Unlike other Medical FSA expenses, which are deemed incurred when the services are rendered, orthodontia expenses are deemed incurred when paid. Therefore, only payments made during your eligibility period or plan year (whichever ends first) may be reimbursed. Proof of payment to an orthodontia provider or a completed Orthodontia Contract is required for reimbursement. You can download a printable copy of the Orthodontia contract by visiting the Navia Benefit Solutions website or calling Navia Benefit Solutions at 1-800-669-3539.

IRS regulations prohibit you from receiving a reimbursement from your Medical FSA for a large quantity of any item in any one transaction. Buying more than three items in any one transaction is considered stockpiling and will not be reimbursed.

The following expenses are not eligible under a Medical FSA. Under no circumstances will the following items be reimbursed. Do not submit claims for these items; they will be denied. For a complete list, visit the Navia Benefit Solutions website or call Navia Benefits Solutions at 1-800-669-3539.

An expense is also not eligible for reimbursement under a Medical FSA if the expense has already been reimbursed under this plan or by any other source. When submitting an expense for reimbursement, you will also be required to certify that you will not seek or be reimbursed for the expense by any other source or insurance.

Navia Benefit Solutions will send you a claim form when you enroll in the Medical FSA. Complete and submit your claim and documentation to Navia Benefit Solutions for reimbursement of incurred expenses. For each claimed expense, documentation must show the: 

• Provider’s name
• Name of the person receiving the service or expense
• Date(s) of service
• Cost
• Type of expense or description of the service(s)

You can use bills from your providers or statements from your insurance company as documentation. Do not submit copies of canceled checks or credit or debit card receipts. Your documentation will not be returned. Remember that:

• Expenses must be incurred during the plan year while you are an active participant in the plan. You may not submit claims for services incurred after your employment has ended, after you lose eligibility for the Medical FSA, after you revoke your election because of a life event, or after you have retired.
• Navia Benefit Solutions will not reimburse any expenses that were incurred before your effective date of enrollment.
• An expense is “incurred” when the health care is provided or the eligible item is purchased— not when you are billed, charged, or when you pay for the medical care.

Navia Benefit Solutions offers several convenient ways to submit your claim and documentation. Choose one of the following:

• Online (you will need to create a login and password)
• Fax: 425-451-7002 or toll-free fax 1-866-535-9227
• Email: claims@naviabenefits.com
• Mail: Navia Benefit Solutions, PO Box 53250 Bellevue, WA 98015-3250
• Mobile App: The MyNavia app is available on both Google Play and the App Store. You can find the app by searching MyNavia or Navia Benefit Solutions.

Navia Benefit Solutions will process your claim within a few business days and either make an electronic funds transfer into your bank account (if you enrolled in direct deposit), or mail you a reimbursement check. If your claim requires additional substantiation, processing could be delayed.

You may enroll in direct deposit at any time by logging into your participant account at the pebb.naviabenefits.com. Keep in mind that deposits by electronic funds transfer may take a few business days to appear in your account. Navia will deduct a $10 fee from your Medical FSA balance for any returned items due to incorrect banking information.

Lost or expired Medical FSA reimbursement checks can be reissued 10 business days after the original check date. A check reissue requires at least one business day to process. Any fees associated with presenting a canceled check will be deducted from your account as well as the face value of the check.
Navia Benefit Solutions will send you a quarterly statement showing your account balance to the mailing address or email address you designate, until your balance reaches $0. It is important to read these statements carefully so you understand the balance remaining to pay for eligible expenses. Remember, all services should be incurred either by the end of the plan year or before the end of the grace period (see below for more information). 

If you have not spent all the funds in your Medical FSA by December 31, 2020, and you are still an active participant (meaning you are still employed and didn’t lose eligibility for the Medical FSA), you may continue to incur eligible health care expenses through the grace period. The Medical FSA grace period ends March 15, 2021.

You must submit all claims for your Medical FSA to Navia Benefit Solutions for reimbursement by March 31, 2021. If you are no longer employed or have retired and still have money left in your account, you can still submit claims for reimbursement by March 31, 2021, so long as the services being claimed took place while you were employed. Money left in your account after that date cannot be refunded and will be forfeited to the plan administrator, the Health Care Authority. This is referred to as the “use it or lose it” rule.

The March 31, 2021 claim submission deadline does not apply to enrollees who had a Medical FSA in 2020 and enroll in a PEBB consumer-directed health plan (CDHP) with a health savings account (HSA) for the 2021 plan year. Because HSA and Medical FSA contributions are both treated as tax-preferred, the Internal Revenue Service prohibits PEBB members from receiving or making any HSA contributions if they still have access to any unused Medical FSA funds on January 1, 2021. If you enroll in a CDHP with an HSA for 2021, you must use all your 2020 Medical FSA funds and have all your claims paid by Navia Benefits Solutions by December 31, 2020. If you don’t, this will prevent you and the state from contributing to your HSA account until April 1, 2021.

If you reenroll in a Medical FSA for the following plan year (i.e., you reenroll in 2021 for coverage in 2022), any claims incurred during the grace period (January 1 through March 15, 2022) will be applied first to unused funds from your 2021 enrollment plan year, whether you use your debit card (see below) or submit a claim.

You can choose your method of communication. For example, if you provide an email address, statements and other communications will be sent automatically to your email. You may change your method of communication or opt out of electronic correspondence either online or by contacting Navia Benefit Solutions directly at any time.

The Navia Benefits Card is a convenient way to pay for eligible out-of-pocket medical expenses for you, your spouse, and your qualified dependents. The debit card is accepted from participating merchants using the Inventory Information Approval System (IIAS) and from medical care merchants using the MasterCard^® system.

Rather than filing a claim and waiting for reimbursement for your out-of-pocket eligible expenses, you can use the debit card at participating merchants to pay your provider directly. The expense is deducted from your Medical FSA balance.

This system allows Navia Benefit Solutions to electronically substantiate the eligibility of your expense. However, the IRS has strict regulations about where the debit card can be used and when follow-up documentation is required for transactions that can’t be substantiated electronically.

Using the debit card does not eliminate the need to submit follow-up documentation when requested by Navia Benefit Solutions. If any of your debit card charges do require substantiation, you will receive a summary of your card activity for those charges from Navia Benefit Solutions at the beginning of each month. We recommend you always save all your receipts and documentation.

If you use the debit card for an ineligible expense, the card will be suspended after 75 days to prevent further use and will remain suspended if the expense is not substantiated or repaid by the end of the plan year. You may still submit claims by email, mobile app, fax, or mail. To correct the reimbursement of an ineligible debit card charge, you must either repay the amount of the ineligible expense back to Navia, or request the substitution or offset of future claims to repay the amount. Navia Benefit Solutions will reactivate the debit card once you reimburse the account for the amount of the ineligible expense.

The debit card feature is only available for the Medical FSA benefit. You must provide a valid email address in order to receive the debit card when you enroll.

You may request a debit card when you enroll or through the Navia Benefit Solutions website. You may request additional cards at no cost. If your debit card is lost or stolen, contact Navia Benefit Solutions immediately so we can help protect your account from unauthorized transactions.