Personal Choice Account - Flexible Benefits Administration

What does Personal Choice Account offer?

Personal Choice Account (PCA) is an administrator of personal savings accounts sponsored and designed by the Internal Revenue Service (IRS). These accounts are sometimes called Section 125 or Cafeteria Plans; however various accounts are part of other IRS Code Sections as well. What these accounts have in common is that they offer employees a choice to pay for certain qualified expenses on a pre-tax basis. Paying for certain benefits with pre-tax dollars reduces the amount you pay in taxes and increases your take-home pay. PCA offers the following plans;

• Health Care Flexible Spending Account (HFSA)
• Limited Health Care Flexible Spending Accounts (LFSA)
• Dependent Care Flexible Spending Account (DCAP)
• Health Reimbursement Accounts (HRA)
• Commute Reimbursement Accounts (CREA)
• Premium Conversion Accounts or Premium Only Plans (POP)

More information about these account types is available throughout this website.

Do I have to participate in all choices?

No. You can enroll in any combination of the choices or none at all. The decision is yours. Participation in these accounts should be based on your need. For instance, if you don’t have children or dependents that require daycare you wouldn’t want to participate in the Dependent Care Flexible Spending Account.

Most people, however, will probably want to participate in the pre-tax premium coverage (Premium Conversion Plan) because there is no risk, only savings! When you are making your choices you should not under estimate value of the Health Care Flexible Spending Account. With it’s vast array of eligible expenses which include your insurance deductible, co-pay, coinsurance and over the counter medications to list just a sample, there are few people that will not save some money using this account.

Are there any risks? What are they?

There is some risk with a Health Care Flexible Spending Account, Dependent Care Flexible Spending Account and Commute Reimbursement Accounts. The Internal Revenue Service (IRS) states that if you do not have expenses that equal or exceed the money you have set aside on a pre-tax basis during a given plan year, you lose the remaining balance in your Flexible Spending Account. There are certain options that an employer may select that will lengthen the time you have to incur services. One such option is referred to as a 2.5 Month Extension. Your Employer will let you know if this is an option that has been chosen for your group.

You can minimize this risk by forecasting your expenses carefully and conservatively. We suggest that you use this Election Worksheet when determining your annual election.

Is this an automatic election or do I need to sign a form?

Flexible Spending Accounts are not enrolled in automatically. This is because you also choose the amount of money you put into the account (we call this your annual contribution or annual election amount). In most cases, you will need to complete a form to enroll in or decline participation in the account. Return your completed form to your Human Resource Department on or before the last day of enrollment. Your Human Resource Department will notify you of the deadline.

In lieu of a form, some employers may have online enrollment. Your Human Resources Department will advise you if that is the case.

Do I need to have a certain insurance plan to participate?

For a Health Care Flexible Spending Account, Dependent Care Flexible Spending Account or Commute Reimbursement Account you do not need to be participating in any specific insurance plan in order to have a spending account. If your employer has chosen an option called “Automatic Reimbursement” for your Health Care Flexible Spending Account, you will need to be insured with a Regence Health Plan to be eligible for the automation. You can still participate and send claims in manually if you are not enrolled in a Regence Health Plan. Your Human Resources Department will explain more about this option if it applies.

Under what circumstances can the annual election be changed?

Changes to your annual election and enrollment in, or termination of, your Health Care Flexible Spending Account can only be made if you experience a qualified event. Some examples include birth, death and divorce. The events are strictly enforced by the IRS and must be processed through your Human Resources Department. In all cases, the change you make must be consistent with the qualifying event. For instance if you have a child you can increase your flexible spending election, but you cannot terminate the account since it’s not consistent with the addition of a dependent. If you have a qualified event you must contact your Human Resources Department right away. They will help you complete the proper forms and determine if your event and change is legitimate.

What is the maximum amount of money that I can put in a (HFSA)?

Under a Health Care Flexible Spending Account your employer will determine the maximum election that you can make. Note that the maximum varies based on the account type.

If I terminate employment, what happens to the money I elected?

You will have a period of time following your termination to submit claims for reimbursement of expenses that were “incurred” prior to your termination date. This period of time is called a run-out period. The “incurred date” is defined as the date that you receive the care or purchase the product which may not be the same as the date that you pay the bill.

Any balance remaining in the account after the run out period will be forfeited unless you elect to continue your participation in the Health Care Flexible Spending Account under your COBRA rights. If you elect to continue under COBRA you will need to make the deposits (we call them contributions) on an after tax basis. Not all employers may be required to offer you COBRA. Please contact your Human Resources Department to discuss COBRA.

Can I transfer funds between my other Flexible Spending Accounts?

No. Each account is separate and distinct. Funds can not be transferred between accounts.

My spouse and I work for the same employer, can we claim each other's expenses?

You can claim your spouse’s expenses on your own account and your spouse can claim your expenses on their account. However, you cannot claim the same expense under both accounts. In other words, you cannot “double-dip.”

Who determines if an expense is eligible?

The Internal Revenue Service (IRS) formulates the guidelines for the reimbursement accounts and determines what is eligible. While the IRS refers to eligible expenses as “213d” expenses, there is truly no such list available. Eligibility for a service is based on several factors and “rules”. Refer to our Knowledge Center for a list of common reimbursable expenses in several categories. Note that in some cases additional documentation will be required to confirm the eligibility of an expense. The lists are not legally binding and are not a guarantee of payment.

How do I get reimbursed for Health Care expenses?

To obtain reimbursement you must complete a Reimbursement Request Form and also provide documentation of the expense. The required information includes; who incurred the service, who preformed the service, what the service was, when it was preformed and how much it cost you.

The best documentation is an Explanation of Benefits (EOB) from your insurance carrier. It provides everything that is needed to document your expense. If the expense was not billed to insurance (for example a vision expense if you have no vision insurance) you should send a copy of the itemized statement for the services that were provided. Documentation for an over the counter expense should include the store receipt which shows the purchase date, the store from which it was purchased, the final cost and a clear explanation of the type of product. Note that some generic brands will be hard to identify. If you have any doubt that PCA will be able to determine the type of product you bought please write it clearly on the receipt. In is also helpful for you to put an asterisk (*) next to the product or to circle it. Please do NOT highlight the receipt.

Please note that we cannot accept cash register receipts, credit card bills, payment on account statements or cancelled checks as proof of service. This flyer -LINK TO CLAIMS SUBMISSION TIPS- will give you tips on how to expedite your claim and ensure that all information is included. Note that incomplete claims may be delayed or denied.

When should I submit my reimbursement request?

You can submit requests for reimbursement at any time during the year. All reimbursements must be received in our office no later than the end of the run out period prescribed by the group. This is the period after the end of the plan year that you have to send in expenses that were incurred during the plan year. PCA suggests a run out period of 90 days after the plan year ends; however, you should confirm your specific run out period either by contacting your Human Resources Department or by contacting PCA by phone or email. Note that expenses must be incurred during your period of active coverage, or by the end of the plan year, whichever comes first. Some employers may also elect an extension period which would affect the date by which services must be incurred.

Can I use my full election even though I haven’t made all the deposits to the account?

It depends on the type of account. With a Health Care Flexible Spending Account you have access to your full election as soon as the plan year begins. In some cases, reimbursement could be slightly delayed (as we set up the plan year or obtain funds from your employer) but you can request reimbursement for the full amount if you have an eligible expense. Your employer will continue to deduct the contributions from your paycheck for the remainder of the year. In a sense, you are being extended credit up to your full election amount.

What happens if I terminate employment but used more from my account than put in?

If you terminate employment, you can continue to submit expenses that were incurred before your termination date. You have until the end of the normal run out period to turn in your claims. If you are reimbursed for eligible services over and above the amount you contributed to the plan nothing will happen. By design, the IRS says that an employer must share the “risk” of a Flexible Spending Account. Just like you risk “loosing money” if you can’t use it, so the employer risks you drawing more from the account than you put in. This guideline applies to Health Care FSA’s only.

Once I file an eligible expense, how long do I have to wait until I am reimbursed?

Personal Choice Account processes claims on a daily basis (Monday through Friday, excluding holidays). Generally, claims are processed within 3-4 days of being received. Some expenses may require additional information and incomplete or inaccurate claims may take longer.

Reimbursement checks are mailed to the employee's home or can be sent via direct deposit to your savings or checking account. In addition, if the reimbursement totals less than $10.00 and you have not elected direct deposit, you reimbursement will be delayed until additional expenses are received and reimbursement exceeds $10.00.

How will I know if you receive my request?

While your request will not show in your online account until it is processed, we can let you know if it’s arrived and awaiting processing. There are several ways. If you send your request via fax, write a note on the cover sheet asking that we call (or email) you to confirm receipt of the fax. One of our Customer Service Representatives will reply approximately 3-4 hours after receipt.

Once claims are received they are sorted and microfilmed. Approximately 24 hours after receipt all claims are “logged”. You can call or email us and we will be happy to look on our log for the claim. In addition, if you are faxing please be sure to save your fax confirmation and original documents. If possible, please avoid faxing your claim multiple times since each request will be added to our inventory and will be processed resulting in duplicates.

Will I receive a report showing the balance in my account?

Yes, with every reimbursement you will receive a check stub showing you the details of your account. During the third quarter of the plan year a report will be mailed to you showing your balance to that point and reminding you to use the money you have set aside or forfeit it at the end of the year. You may also access this information 24/7 on this website or by telephone/email 8:00am - 5:00pm PST.

How is orthodontia reimbursed?

Click here for a brochure outlining all of the details regarding orthodontic reimbursement.

When are expenses considered to have been incurred?

The IRS defines “incurred” as the date a service or item is provided or purchased; not when the employee is formally billed or pays for the service.

• For multiple step procedures (such as crowns and dentures) the date incurred is when the device is ordered.
• For items that you must order and later pick up (such as contacts and eyeglasses) the date incurred is the date the item was ordered.
• For mail order items (such as prescriptions) the date incurred is when the item is ordered.
• For prescriptions picked up from a pharmacy, the date incurred is the date that the prescription was ordered.
• Orthodontic treatment is the exception to this rule. Click here for specific information related to the reimbursement of orthodontia.

What type of documentation should I submit for a prescription?

The pharmacy receipt (not the cash register receipt), often times called a “script”, that includes the pharmacy name, patient name, date the prescription was filled, the name of the drug, and dollar amount should be submitted with your claim. Another easy way to submit prescription expenses is to ask your pharmacy to print a listing of all your prescription purchases for a given time period for each family member and submit that with your claim form.

Can I buy boxes of band-aids at the end of the year to claim the balance of my money?

This is referred to by the Internal Revenue Service as “stockpiling” and is not allowed. The regulations say that the quantities purchased must reasonably be used by the participant and their family within the plan year. Updating your medicine cabinet may be allowed, however, PCA will use our judgement in cases of apparent stockpiling and will limit the total reimbursement to a resonable amount.

Will I need to submit additional information to prove an expense is eligible?

In some cases, you will be asked to provide a “Letter of Medical Necessity” or “Certification of Medical Necessity” from a physician to document your request. For example, treatments such as massage therapy or weight loss programs that can be for both medical and non-medical reasons may be subject to this requirement. If you are seeking reimbursement for one of these items, a Letter of Medical Necessity or Certification of Medical Necessity may be required each plan year.

There are several resources available in our Knowledge Center that discusses these requirements. If you submit a request and we find that additional information is required you will receive a letter from us. If you know in advance that a letter is needed, feel free to send it along with your claim initially.

I've deducted healthcare expenses on my taxes. Can I do this while enrolled in a flex plan?

Any amount reimbursed by a flexible spending account reduces, dollar for dollar, the amount you may claim on your tax return. Being reimbursed for expenses and also claiming them as itemized deduction is commonly known as double dipping and is not allowed under the IRS regulations.

My request has been paid but I didn’t receive the check. What should I do?

Simply contact us by phone or email so we can request a “stop pay” on the check and have it reissued to you. We are required to wait 15 days after the date of issue before a stop can be done. After requesting a reissue, if you locate the original check, do not try to cash it. Your bank may charge you a fee for attempting to do so.

I accidently shredded my check. Now what?

Simply contact us by phone or email and we will have the check reissued. If you know that the check has been destroyed, we can request a reissue right away. If you’re not sure that the check has been destroyed (i.e. you just haven’t received it) then we are required to wait 15 days after the day of issue before it can be reissued to you.

How do I report a change of address?

You can change your address with us in writing (via email or fax). Please indicate your old address and your new address. You must be sure to also change your address with your employer or there is a chance that your address will be inconsistent and could get changed back.

I have direct deposit into a bank account that I have now closed. What should I do?

You’ll need to request (in writing) that your direct deposit be cancelled. We will then set your account to pay you by check, until such a time as you complete a new direct deposit form.