Healthcare Flexible Spending Account

Our healthcare FSA helps you save money by allowing you to pay for healthcare expenses - such as medical and pharmacy copays, deductibles and vision and dental costs-with funds deducted from your paycheck before taxes are applied. Our FSA plan is administered by PayFlex.

Who You Can Cover

Use the healthcare FSA to pay for eligible healthcare expenses for you, your spouse or your tax-dependent children. Your spouse and children don't need to be enrolled in Carilion's medical or dental plans for you to use the healthcare FSA for their expenses.
The FSA cannot be used to pay for healthcare expenses for a domestic partner or a child who is not your tax dependent. This is a federal tax requirement.

What You Can Cover

Eligible expenses are determined by the Internal Revenue Service (IRS). Visit PayFlex's FSA website for a list of eligible expenses.
IRS guidelines require some FSA expenses to be documented as medically necessary with either a prescription from your physician or a Letter of Medical Necessity .
- The provider must indicate the specific diagnosis, the specific treatment needed, the length of treatment and how the treatment will help the medical condition.
- The signed prescription or Note of Medical Necessity must be completed and dated prior to the first date of service or product purchased. You will need to submit the prescription or Note of Medical Necessity with the first claim you submit for the service or product.
- A prescription or Note of Medical Necessity is good for 12 months. If your treatment continues beyond 12 months, you'll need to provide an updated prescription or Note of Medical Necessity every 12 months during your treatment for it to be considered an eligible expense.

COVID-19 Aid, Relief, and Economic Security (CARES) Act

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, is a package of measures introduced by the Senate, in response to the COVID-19 pandemic. Within the bill, the following sections may benefit PayFlex members:

Section 3702: Over-the-Counter (OTC) Drugs and Medications without Prescription.
This section includes the following two provisions. These OTC changes are effective for expenses incurred after Dec. 31, 2019, These provisions don't have an expiration date.
- This law allows participants to use Flexible Spending Accounts (FSA) funds to purchase over-the-counter (OTC) drugs and medications, including those needed in quarantine and social distancing, without a prescription from a physician.
- This law also adds feminine hygiene products to the list of eligible over-the-counter items.
If the PayFlex debit card does not work at time of purchase, members can pay out of pocket, save the receipt, and request reimbursement from their PayFlex account funds.

How the Healthcare FSA Works

You can contribute up to $2,750 per year to your healthcare FSA in 2020.
You can spend the dollars in your account on out-of-pocket healthcare expenses through March 15 of the following year. Any dollars not spent by March 15 will be forfeited.
All claims must be filed by March 31 following the end of the plan year.
Create a secure account through PayFlex's website to view up-to-date account balance information, make changes to your personal information and order additional cards.
If you have an account with Aetna, you may also access your FSA account through the Aetna Navigator at MyAetna.com.

If you leave Carilion mid-year, you are able to submit claims for reimbursement for expenses that incurred up to your separation date. You have until March 31 of the following year to submit documentation for reimbursement of FSA eligible expenses that incurred up until your separation or retirement date.

Using the FSA Debit Card

When you enroll in our healthcare FSA, you'll receive an FSA debit card from our FSA vendor, PayFlex, that you use to pay for eligible healthcare expenses. Using the debit card allows you to use the money in your FSA directly, rather than paying for the service up front and then filing a claim for reimbursement.
When you receive your card, it is loaded with the entire amount of your annual election so you can begin using it on your eligibility date for healthcare expenses.
To set up a Personal Identification Number (PIN), call customer service at 1-888-999-0121. A PIN can be created at any time.
- If you order a card for your spouse or dependent, they will use the same PIN you use.
If your provider does not accept the FSA debit card, you can file a claim for reimbursement using the FSA Claim Reimbursement Form.
Save all of your receipts. The IRS requires all expenses be properly documented as FSA eligible.
For purchases that do not match our plans' copay amounts or are not made at an IRS-approved retailer, PayFlex will send you a request for documentation, such as an explanation of benefits from your insurance carrier. This request will be sent by mail to your home or to an email address that you provide.
If you do not provide documentation that your expense is eligible or do not repay the plan within 45 days of the transaction date, your debit card will be suspended and deactivated. Once you resolve the transaction in question, either by providing appropriate documentation or by repaying the plan, you'll be able to use your debit card again.
You will be taxed on the amount of any transaction not verified by the end of the plan year and appropriate taxes will be withheld.
- You should consult a financial or tax advisor for more information on the tax implications for your specific situation.

Creating an Online Account

There are two ways to create an online account:
- If you are not an Aetna member, visit PayFlex.com to create an account. Click on Register and follow the online prompts.
- If you are an Aetna member visit the Aetna Navigator at Aetnanavigator.com and access your existing account or create a new account.
From your online account you can view account balances, file claims, set up direct payment to you or your provider, and many more options. Access the PayFlex Quick Reference Guide for a list of available options and instructions.

PayFlex Mobile App

Get access to your PayFlex account with the free PayFlex Mobile Application. This app makes it easy for you to access your FSA account at any time. Available for iPhone and iPad mobile digital devices as well as Android and Blackberry smartphones.
The PayFlex Mobile app lets you:

View your account balance and manage your account funds.
Request reimbursement and view transaction history.
View PayFlex Card, your account debit card, purchases and submit documentation (if applicable).
View your benefits plan information (if applicable).
View a list of common eligible expense items.

For more information and instructions on how to register, please review the PayFlex Mobile Reference Guide.

When You Still Have Money in Your Account from Last Year

If you still have funds in your FSA account from the previous years, any debit card transactions between January 1 and March 15 will be paid using the previous year's funds. This is to ensure you do not forfeit those funds.

We encourage you to file claims for the previous year before using the debit card for the current year's expenses.