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Frequently Asked Questions
  • Health Care Flexible Spending Account (FSA)
    • *Note: This information is general in nature for informational purposes only. Please refer to your employer’s plan for specific information about your plan.
      Do I have to enroll in my employer’s medical or dental plan to participate in the health care FSA?
      Your plan will determine this. Although your employer can require that you take the medical or dental plan in order to have a health care FSA, not all plans are designed this way. You should check your plan documents to confirm this. 
       
      I have a health care FSA. If I’m contributing throughout the year, how much will my FSA cover for a claim in the beginning of the year?
      With a health care FSA, your full election amount is available on the first day of the plan year. This means that you can use your entire election on day one of the plan year.
       
      Example: You elect to contribute $1,200 for the plan year. In January, you have contributed $100. ($100 x 12 months = $1,200) In that same month, you receive health care services that cost you $1,000. At this point, you haven’t submitted any other claims. This means, you’ll receive the full amount of the claim from your FSA. You don’t have to wait until you actually contribute this amount to your health care FSA.
       
      What expenses are eligible under a health care FSA? 
      Generally, expenses that are medically necessary are considered eligible. This means if you need the service or product for your health it may be an eligible expense. This includes co-payments, co-insurance and deductibles. You can view a list of common eligible expenses on this website. You can also find more information at www.irs.gov. Refer to IRS Publications 969 and 502. You should also check your plan documents for eligible expenses under your plan.
       
      Can I use my FSA to pay for over-the-counter (OTC) items, supplies, drugs and medicines?
      Yes. However, there are different rules on how you can use your FSA to pay OTC items, supplies, drugs and medicines. You can use your PayFlex Card® to pay for OTC items and supplies. These include items such as bandages, hot/cold packs, thermometers, first aid kits, home diagnostic tests and diabetic supplies. You can also pay for these items out of pocket and then submit a claim to us. 
       
      For OTC drugs and medicines, you can’t use your PayFlex Card. First, you’ll need a written prescription from your doctor. Then you’ll have to pay for the OTC drug or medicine out of pocket and then submit a claim to us. You’ll need to include your written prescription and the detailed receipt with your claim.
       
      May I submit eligible health care expenses incurred by my spouse and dependents?
      Yes. You can be reimbursed for eligible health care expenses that you, your spouse and eligible tax dependents incur during the plan year. This is true even if you don’t cover your spouse and dependents on your health plan.
       
      Why do I have to show that an expense was medically necessary?
      There are some products or services that aren’t always used for medical care. Some products may be used for general health reasons. Two examples are massage therapy and weight loss programs. If you use the product or service to treat a medical condition, you’ll need to show that. This is “evidence of medical necessity.” You can submit a prescription or letter from your health care provider. You can also have your health care provider complete and sign a Letter of Medical Necessity form. You can find this form in the Resource Center.
       
      Can I pay my spouse’s health insurance premiums through my health care FSA?
      No. Premiums aren’t an eligible expense for the health care FSA. You can view a list of common eligible expenses on this website. For more information, visit www.irs.gov. There you can view IRS Publications 969 and 502.
  • Changing My Election
    • If I have funds left in my TexFlex health care account at the end of the year, can I transfer those funds to my TexFlex day care account?
      Each account is a separate plan which means funds cannot be transferred between accounts.

      I've used all my money in my TexFlex account. Can I now elect to put more money into my account?
      The IRS allows changes only when there is a Qualifying Life Event (QLE), such as marriage, divorce, birth, death, etc. If you experience a QLE and you have not contributed the maximum amount ($2,500), you can put more money into your TexFlex account.

      I made a mistake on my election. Can I correct it?
      You can make changes to your election during Annual Enrollment. During the plan year you can only make a change to your election when you have a Qualifying Life Event.

      Can I decrease my TexFlex health care election or waive my participation?
      You may decrease your election or waive participation if you experience certain Qualifying Life Events such as divorce or death of a dependent or if you are placed on a Leave of Absence that is protected by the Family and Medical Leave Act (FMLA).

      Can I increase my TexFlex health care election or enroll mid-plan year?
      You may increase your election or enroll mid-plan year if you experience a Qualifying Life Event that adds a dependent to your household such as a birth of a child, marriage, adoption, etc.

      I have learned that I will need expensive medical/dental treatment – can I increase my TexFlex health care election or enroll in the plan?
      You can only change your election if you experience a Qualifying Life Event (QLE) such as marriage divorce, birth, death, etc. If you experience a QLE and you have not contributed the maximum amount ($2,500), you can put more money in your TexFlex account.

      You can only enroll in a health care account:
      • During Annual Enrollment
      • Within 31 days of experiencing a QLE, such as marriage, birth, death, etc., or
      • Within 31 days of starting employment

      Can I decrease my TexFlex day care election or waive my participation?
      You may decrease your election or waive participation if your dependent care expenses decrease or your dependent no longer qualifies as an eligible dependent.

      This information is intended to be accurate, but the terms of the Plan and rules of the IRS will govern in the event of an inconsistency.
  • Filing Claims
    • What does the term “expense incurred” mean?
      The IRS considers an expense to be “incurred” at the time you receive the care or the date of service, not when you are billed or pay for the expense. The expense must be incurred within the TexFlex plan year and while you have coverage for you to receive reimbursement.

      For example: If your doctor bills you on October 1 for services on October 15, these would not be considered incurred expenses until October 15.

      What happens if I forget to sign the paper claim form?
      IRS regulations require that you provide a statement saying the expense has not been reimbursed, and that you will not seek reimbursement elsewhere. This statement is on the paper claim form and in the online claim feature. When you submit a claim, you must sign it. If you do not sign the claim, it will be denied. To get reimbursed for the claim, you will have to sign and resubmit it. See “Health and Dependent Care Claim Filing Instructions” in My HealthHub Resources under Administrative Forms.

      Can I use my cancelled check as documentation of my claim?
      No. A cancelled check is not acceptable documentation when filing a claim.

      What type of documentation should I submit for a prescription?
      You should include the pharmacy receipt, often called a “script,” with your claim. This receipt will include the pharmacy name, patient name, date the prescription was filled, the name of the drug and the dollar amount. Note: You cannot use the cash register receipt as documentation.

      Another easy way to submit prescription expenses is to ask your pharmacy to print a list of all your prescription purchases. You can do this for a given time period for each family member and submit that with your claim form. Many pharmacies allow customers to set up accounts online so they can print a list of their prescriptions.

      How long after the end of the plan year can I file claims?
      You may file claims until December 31 following the end of the plan year. If you submit paper claims for expenses that you incurred during the plan year, they must be postmarked no later than December 31. Claims postmarked after December 31 will not be processed. You should file your claims as you incur expenses. If claims are submitted on December 31 and they have missing information, you may not receive your reimbursement.

      My coverage under the TexFlex plan started on July 1. Can I submit health care expenses that I incurred before July 1?
      No.  You can only submit expenses that you incur during your period of coverage.  This means that you can submit claims for eligible expenses that you incur on or after July 1.

      My plan year begins September 1 and ends August 31. If I incur an eligible expense (for ex., ordering eyeglasses or filling a prescription) in August but wait until September to pick them up, will this be an August claim or a September claim?
      This would be an August claim. Claims are processed based on the date of service or the date that the order created the expense. 

      My plan year begins September 1 and ends August 31. I’m having dental work or a procedure done in September, but my provider wants me to prepay in August. Is this an August claim or a September claim?
      This would be a September claim. Claims are processed based on the date the service is provided, regardless when you pay for the service.

      Do I need to list dependents on my claim form?
      For health care expenses, you do not need to list your eligible dependents on the claim form when filing a claim.

      For day care expenses, you will need to list your qualifying person on your claim form. A qualifying person includes:
      • Your spouse (including a common-law spouse);
      • Your natural or adopted child;
      • Your stepchild whose primary residence is with you (not on another health program);
      • Your grandchild who is claimed as a dependent on your federal income tax return;
      • A child for whom you are legal guardian, whose primary place of residence is with you; or
      • A child with whom you have established a parent-child relationship, whose primary residence is with you.
      For information about qualifying persons, please refer to IRS Publication 503.
       
      If I terminate employment, can I still file claims?
      You can file claims for eligible expenses through the end of your run out period (December 31).

      When your employment ends, you may continue to contribute to your account and spend your TexFlex dollars through the end of the plan year. If you leave money in your account after December 31, you will lose those funds.

      If you choose not to continue your TexFlex account through the end of the plan year, then your coverage will end when you leave the company. This means you would no longer make contributions to the TexFlex account. You will only be able to submit claims for expenses incurred between September 1 and your termination date. The deadline to submit claims would be December 31 of the following year.
  • TexFlex Day Care Account
    • What is a TexFlex day care account?
      A TexFlex day care account is a Flexible Spending Account that lets you pay for eligible day care expenses with tax-free money. You contribute to a day care account with pre-tax money from your paycheck. This, in turn, lowers your taxable income.

      How does a TexFlex day care account work?
      With a TexFlex day care account, expenses must be work-related. This means that your dependents need the care so that you can work.
      • If you are married, you must both be working. If just one of you is working, the other spouse must be actively looking for work; be a full-time student; or be unable to care for him or herself. Note: Unpaid or minimally paid volunteer work does not count as employment.
      • The expenses must be for a qualifying person. A qualifying person is your dependent child who is younger than age 13 or a spouse or tax dependent who is not physically or mentally able to care for him or herself.
      • You must receive these services from an eligible care provider. This can include providers such as a licensed child care facility, an adult day care center and possibly a summer day camp.
      • The day care provider cannot be your tax dependent, your child who is under age 19 at the end of the year, a person who was your spouse any time during the year or the parent of your qualifying person. The expenses must be for services you received during the plan year and while the qualifying person regularly spends at least 8 hours each day in your home. They cannot be for future services. For example, you prepay your child’s summer day camp. You cannot receive reimbursement until after your child attends the camp.
      • The annual reimbursement is limited to the lesser of your earned income for the year or the cost of care, up to $5,000. If you are married, this limit is based on the income of the lower paid spouse and whether you file separate tax returns.

      What is the benefit of enrolling in a TexFlex day care account?
      Your contributions to a TexFlex day care account are deducted from your pay on a pre-tax basis. Therefore, you pay less in Federal and Social Security payroll taxes.
       
      How much can I contribute to a TexFlex day care account?
      Typically, the most that you can contribute to a TexFlex day care account is $5,000. This is per household per year. This means that if you and your spouse each have a day care account, you are limited to $5,000 between the two of you. Keep in mind, this amount may be less based on earned income and tax filing status. If you’re married and filing your taxes separately, then the maximum amount each parent can elect is $2,500 per year.
       
      How much money can I expect to save in taxes with a TexFlex day care account?
      When you contribute to a TexFlex account, that money is deducted from your pay on a pre-tax basis. This means that you pay less in Federal and Social Security payroll taxes. Generally, federal taxes range from 15% to 28% and Social Security taxes are 7.65% of your pay.

      What happens if I have funds left in my account at the end of the plan year?
      Your TexFlex account has a use-it-or-lose-it-rule, which is set by the IRS. This means any funds left in your account at the end of the run out period will be forfeited. Your run out period ends on December 31. The last day to spend your TexFlex day care dollars is November 15. Any expenses incurred between September 1 and November 15 of the following year must be submitted to PayFlex by December 31.

      You can avoid losing money at the end of the year. Review your current and prior years’ expenses. This will help you estimate what you may spend in the next plan year. Make sure to be conservative while planning for predictable expenses.
       
      Does the $500 carryover apply to TexFlex day care accounts?
      No. The carryover doesn’t apply to a day care accounts. It is only available for TexFlex health care accounts. The day care account still includes the grace period and any funds left in your account after the end of the run out period (December 31) will be forfeited. This means you must incur expenses between September 1 and November 15 of the following year. The last day to submit claims is December 31.

      What is a run out period?
      A run out period is the additional time you have to file claims. Your run out period is 122 days.  Your plan year is September 1 through August 31. With the run out period, you have until December 31 of the next year to file claims. Note: You must have incurred these claims during the plan year.

      Can I file a day care claim at the beginning of the month for that month?
      You can file a claim only after you have received the service. This is regardless of when you pay for the service. It is recommended that you file your claim after the service has been provided, in this case at the end of the month. If you file a claim prior to the date of service, it will be denied and you’ll have to resubmit the claim.

      How do I file a day care claim?
      You can file a TexFlex day care claim for services you have received. This is regardless of when you pay for the service. This is an IRS rule. For example, you receive the day care services from September 16 through September 20. You can submit your claim after September 20. If you submit the claim before you receive the day care service, your claim will be denied and you’ll need to resubmit it.

      You may submit a paper claim to PayFlex at the end of each week or month that you receive the day care services. You’ll need to include a receipt or statement with your claim or your day care provider must sign the form. If you prefer, you can submit a claim online. You’ll need to register your account at www.texas.payflex.com and login to use the File A Spending Account Claim tool.

      My enrollment material says my day care expenses must be "work-related." What exactly does the term "work-related" mean?
      Work-related means that you pay for dependent care so that you can work and earn an income. If you are married, your spouse must also work. If just one of you is working, then the other one must be actively looking for work; be a full-time student; or be incapable of self-care. Note: Unpaid or minimally paid volunteer work does not count. For the IRS definition of work-related expenses, please refer to IRS Publication 503.
       
      What expenses are eligible under the TexFlex day care program?
      Day care expenses must be work-related.  This means that you pay the day care services so you can work.  If you’re married, your spouse must either be working, looking for work, be a full-time student or be incapable of self-care. 
       
      You can view a list online of common eligible expense items. At the top of the page, before you log in, click on Common Eligible Expense Items.  You can also view the list after you log in.  Under Quick Links, click on Common Eligible Expense Items. For more information, click on My HealthHub Resources and select IRS Publication 503.

      If I participate in the TexFlex day care program, do I need to report anything on my income tax return at the end of the year?
      Yes. You'll need to file IRS Form 2441-Child and Dependent Care Expenses with your Form 1040. (Go to www.irs.gov to see Instructions for IRS Form 2441.) On this form, you’ll have to identify all persons or organizations that provided care for your child or dependent. If you have questions about this form please speak with your tax advisor. PayFlex can’t give tax or legal advice.

      I signed up to contribute $400 per month into my day care account. My actual expenses are closer to $500 per month. Should I submit my claim form for $400 or for $500?
      You should file your claim for the actual amount of charges; $500 in this case. You will be paid up to the amount of money available in your account (less prior reimbursements). Any amount after that would be in a “pending” status.  Once more funds are deposited into your account; we will pay the rest of the claim.

      If I have the TexFlex day care account, can I also use the Child and Dependent Care Tax Credit?
      Generally, if you have a TexFlex day care account you cannot also take the full tax credit. Please consult your tax advisor for specific information based on several variables such as tax filing status, number of dependents, earned income, tax bracket, etc. to learn which option is most beneficial for your unique situation.
  • TexFlex Health Care Account
    • What is a TexFlex health care account?
      A TexFlex health care account is a Flexible Spending Account (FSA) that lets you pay for eligible out-of-pocket health care expenses. You contribute to a health care account with pre-tax money from your paycheck. This, in turn, lowers your taxable income.

      How does a TexFlex health care account work?
      Managing your FSA is as easy as 1-2-3.
      1. Estimate how much you will spend on eligible health care expenses during the plan year. This is what you pay out-of-pocket.
      2. Decide how much you wish to set aside into your health care account up to the IRS limits. Your employer will deduct that amount from your paycheck in equal amounts each pay period. These deductions are pre-tax.
      3. As you incur eligible expenses throughout the year, you have two ways to use your funds. If you elect the TexFlex debit card, you can use that to pay for eligible expenses. If you don't have or use the card, you can pay for the expense with cash, check or personal credit card and then submit a claim for reimbursement.
       
      What is the benefit of enrolling in a TexFlex health care account?
      Your contributions to a TexFlex health care account are deducted from your pay on a pre-tax basis. Therefore, you pay less in Federal and Social Security payroll taxes.

      In addition, beginning in Plan Year 2015 (9/1/2014 - 8/31/2015), you can carry over up to $500 in unused funds to the next plan year, as long as you’re an active employee on the last day of the plan year. The carryover will replace the grace period. This means the last day to use your health care dollars will be August 31. Any unused funds greater than the carryover limit will be forfeited after December 31.
       
      How much money can I expect to save in taxes with a TexFlex health care account?
      When you contribute to a TexFlex account, that money is deducted from your pay on a pre-tax basis. This means that you pay less in Federal and Social Security payroll taxes. Generally, federal taxes range from 15% to 28% and Social Security taxes are 7.65% of your pay.

      Do I have to enroll in my employer’s medical or dental plan to participate in the TexFlex health care account?
      No. You don’t have to enroll in your employer’s medical or dental plans to participate in the TexFlex health care account.

      May I submit expenses incurred by my spouse and dependents?
      You can be reimbursed for eligible medical expenses incurred by you, your spouse and eligible tax dependents. This is true even if your spouse and dependents are not on your health plan.

      What happens if I have funds left in my account at the end of the plan year?
      Starting Plan Year 2015 (9/1/2014 - 8/31/2015), you can carry over up to $500 in unused funds to the next plan year, as long as you’re an active employee on the last day of the plan year. The carryover will replace the grace period. This means the last day to use your health care dollars will be August 31. Any unused funds greater than the carryover limit will be forfeited after the end of your run out period (December 31). Any expenses you incur between September 1 and August 31 of the following year must be submitted to PayFlex by December 31.

      You can avoid losing money at the end of the year. Review your current and prior years’ expenses. This will help you estimate what you may spend in the next year. Make sure to be conservative while planning your contribution.

      Does the amount I carry over change the amount I can contribute to the health care account?
      No. You can still contribute up to the IRS limit of $2,500 each plan year. If you have a carryover amount, it will be added to the amount you elect to contribute to the TexFlex health care account. Therefore, for Plan Year 2016 you could have up to $3,000 in your health care account if you roll over $500 from Plan Year 2015 and contribute the full $2,500.

      What is a run out period?
      A run out period is the additional time you have to file claims. Your run out period is 122 days.  Your plan year is September 1 through August 31 of the following year. With the run out period, you have until December 31 of the following year to file claims. Note: You must have incurred these claims during the plan year.
       
      Where can I find out if a product or service is an eligible health care expense?
      You can view a list online of common eligible expense items.  At the top of the page, before you log in, click on Common Eligible Expense Items.  You can also view the list after you log in.  Under Quick Links, click on Common Eligible Expense Items. For more information, click on My HealthHub Resources and select IRS Publications 969 and 502.

      Are over-the-counter (OTC) medicines and drugs eligible expenses?
      Yes. However, federal law requires a doctor’s prescription to get reimbursed for OTC medicines and drugs.  You cannot use your TexFlex debit card to pay for these items. You’ll need to get a written prescription from your doctor, then pay for the items and submit a claim to PayFlex with your receipt and prescription.

      How are orthodontia expenses reimbursed under the plan?
      The IRS recognizes that orthodontia treatment is different from any other type of health care expense. For reimbursement of orthodontia expenses, what you will need to submit depends on what is allowable under your plan and the payment option you choose. Reimbursement of orthodontia expenses can be handled in these ways:
      • Coupon Payment Option – This option works best when the orthodontist provides either a coupon book or a monthly reminder statement of expenses. You must submit the coupon or an itemized statement of your orthodontia expenses with a completed claim form. You will do this as the service is provided.  
         
      • Monthly Payment Option* – This Auto Pay option allows you to set up recurring monthly reimbursements.  To do this you must submit a copy of the contract or agreement** that you have with the orthodontist along with the completed claim form.  Be sure to check the box on the claim form indicating you wish to establish automatic monthly reimbursements.  Once we process the first claim, we will automatically reimburse you each month, according to the contract.  This eliminates the need for you to send a claim form in each month. Note: You must be enrolled in a TexFlex health care account and have funds available.  You will receive monthly payments on or about the due date stated in your agreement.  You do need to send a new claim form with your contract agreement at the beginning of the next plan year if you wish to continue.

        *If you use the Auto Pay option, you cannot also use the TexFlex debit card for these expenses.
        **You can get a payment contract or agreement from your orthodontist.  That agreement must include the patient’s name; date that the service began; the length of service; cost of the initial banding work; and the amount you must pay each month.

      • Total Payment Option – If you paid the full amount of treatment when the service began, you can receive reimbursement for the amount you paid out-of-pocket.  We will reimburse you up to your FSA election amount, minus any previous FSA payments.

        With this option, you must include a copy of your paid receipt.  You also need to include an itemized statement showing the provider’s name, patient’s name, date treatment started, the amount you paid and amount insurance will pay. Note: You can only submit this once for reimbursement.

      Do my health care expenses need to be medically necessary for me to be reimbursed?
      Your TexFlex health care account can only reimburse you for medically necessary expenses. Some elective procedures treat a specific medical condition and would be an eligible expense. For example, LASIK eye surgery is elective; it also treats a medical condition. A chemical peel to correct facial wrinkling is elective. However, it is purely cosmetic and is not eligible.

      What do I need to submit to PayFlex to verify my expense was for a medically necessary treatment?
      In some cases, we will ask you for a "Letter of Medical Necessity" from your doctor. This will confirm that your expense is eligible. For example, treatments such as massage therapy or weight loss programs can be for both medical and non-medical reasons. If the massage therapy or weight loss program is needed to treat a medical condition, you can use your TexFlex dollars as long as you have your doctor complete a Letter of Medical Necessity Form. This can be found in My HealthHub Resources under Administrative Forms.  You must send this form to PayFlex with your claim form and supporting documentation.   Note: We will review each claim. If more information is needed, you will receive a letter. 

      If I have to travel out of state for health care, are my travel expenses eligible?
      If the travel is for medical care, the expense may be eligible. The travel must be primarily to receive medical care and not for pleasure. (See IRS Publication 502 for more information.)

      Can I use my TexFlex health care account to pay for my spouse’s health insurance premiums?
      No. The TexFlex health care account is a Flexible Spending Account (FSA).  Insurance premiums are not an eligible expense for an FSA.

      If my spouse and I are both participants under the Group Benefits Program (GBP), can we claim each other's expenses on our TexFlex accounts?
      You can only claim each expense once. You can claim your spouse’s expenses on your account; your spouse can claim your expenses on his or her account. However, you cannot both file for the same expense under both accounts. In other words, you cannot “double-dip.”

      What happens to my account if I leave the company?
      When your employment ends, you may continue to contribute to your account and spend your TexFlex dollars through the end of the plan year. Should you choose to do so, you can pay your remaining contribution back on a monthly basis. This will be with after-tax dollars.

      However, you cannot use your TexFlex debit card after your termination date. You can pay for expenses with cash, check or a personal credit card and submit claims for reimbursement. You can do this online or you can fill out a paper claim form and fax or mail it to PayFlex.

      If you choose not to continue your TexFlex account through the end of the plan year, then your coverage will end when you leave the company. This means you would no longer make contributions to the TexFlex account. You will only be able to submit claims for expenses incurred between September 1 and your termination date. The deadline to submit claims would be December 31 of the following year.

      If I terminate employment in the middle of the plan year, can I still carry over funds into the next plan year?
      No. You must be an active employee on August 31 to carry over any money into the next plan year. If you are an active employee on the last day of the plan year (August 31), you can carry over up to $500 in unused health care funds into the next plan year.
  • TexFlex Debit Card
    • What is the TexFlex debit card?
      The TexFlex debit card makes it easy for you to spend the money in your TexFlex account.  If you enroll in both the health care and day care accounts and you elect the card, you will use one card for both accounts. You can use the card to pay for your eligible expenses. When you use the card to pay for eligible expenses, the funds automatically come out of your TexFlex account, if funds are available.  You can use the card at most merchant locations wherever MasterCard® is accepted. This includes physician and dental offices, pharmacies and vision care locations.
       
      Note: There is an annual $15 fee to use the card.  If you enroll in both the health care and day care accounts, you only have to pay the fee once. 

      How does the TexFlex debit card work?
      The TexFlex debit card works like any other debit card. It gives you immediate access to your TexFlex account funds so you don't have to use money from your own pocket.

      You can use the TexFlex debit card at most merchants that accept MasterCard®, such as physician offices, hospitals, dental offices, pharmacies (including mail order), hearing and vision care providers, and some day care centers.  You can use the card as “debit” or “credit.” If a merchant asks you to choose "debit," you’ll need a PIN to complete the transaction.  To create a PIN, call Card Services at 1-888-999-0121. If you order a card for your spouse or dependent, they will use the same PIN you use. 
       
      After you swipe the card, our system automatically confirms whether you have enough funds to pay for the expense.  If you have funds available, your expense will be taken out of your account. 

      Note: The TexFlex debit card has an annual $15 fee, which covers as many cards as you need for your entire family. One card fee covers both the TexFlex health care and day care accounts.

      Where can I use my TexFlex debit card?
      If you have a TexFlex health care account, you can use your card to pay for eligible health care products and services. This includes doctor and dentist visits, hospital stays, prescriptions and hearing and vision care. You may also use your card at some discount and grocery stores. These stores must have a system that can process a health care card.
       
      If you have a TexFlex day care account, you can use the card to pay for eligible day care expenses.  The merchants and providers must accept MasterCard® for your card to work.

      Is this process paperless?
      Not always. When you use your debit card, you do not need to complete claim forms. However, there may be times when you’ll have to provide additional documentation for a debit card payment. This is part of the IRS guidelines.

      You should keep all receipts, Explanations of Benefits (EOBs) and itemized statements for each debit card purchase for the entire plan year.  If we need documentation from you, we’ll post an alert message online or send you a Request for Documentation letter.   We do this when we need to verify that you used your card to pay for an eligible item or service.  If you do not respond to the request, we’ll suspend your card.

      Can I buy over-the-counter (OTC) items with the card?
      You can use your funds to pay for OTC items and supplies. These are items such as bandages or a home diagnostic test. You can also use the funds to pay for diabetic supplies and equipment such as crutches. However, the rules are different for OTC drugs and medicines.   You cannot use the TexFlex debit card to pay for OTC drugs or medicines.  You’ll need to get a written prescription from your doctor.  Then pay for these items with cash, check or personal credit card and submit a claim for reimbursement.  Be sure to include the receipt and written prescription when you submit your claim.
       
      Can I use my TexFlex debit card for my dental expenses?
      Yes. You can use the TexFlex debit card for dental expenses. Please be sure to wait until you receive the final amount from your insurance provider so that you know how much you owe for the dental care. If you use the TexFlex debit card before your insurance provider has determined how much you have to pay, you may over pay from your TexFlex account.  You should not pay an "estimated" or "pending" amount.

      Why did I receive a Request for Documentation letter for my dental expense?
      The TexFlex debit card is set up to approve copayments that match your employer’s plan. You may have received a letter because your expense did not match your employer’s dental copay.  In that case, we must request documentation to verify the expense is eligible. This is an IRS rule. There are some dental expenses that fall under the ineligible category such as teeth whitening and dental veneers. Therefore, we are required to make sure that you are not using your health care funds for ineligible expenses.
       
      Please note, that although medical expenses may be clearly associated to a dentist, there still may be instances where you will need to provide an itemized invoice (documentation, EOB, receipt) to verify that you used your card for an eligible medical expense. The additional documentation required is to assist PayFlex with verifying that the expense is eligible. Not all dental procedures are eligible for reimbursement according to the IRS. We recommend that you keep all EOBs, itemized statements and detailed receipts for the plan year.

      What documentation should I provide when I receive a request for documentation?
      Please send the Explanation of Benefits (EOB) from the insurance company showing your financial responsibility. If you don’t have an EOB for the expense, you’ll have to send a detailed receipt or itemized statement. Remember, if the documentation shows "estimated" or "pending" insurance payment, the card payment cannot be approved. You can only use your debit card to pay the final amount that you owe.  Note: If you do not respond to the request, we will suspend your card until you send in the requested documentation or pay back the account.

      How can I reduce the number of Request for Documentation letters I receive?
      You should pay for prescription drugs and copay items at approved merchants; this will help you to reduce the number of letters you receive. However, requests for dental, vision and hospital expenses are common, as they do not always match one of the copays on your employer’s plan. We recommend that you keep all Explanations of Benefits (EOBs), detailed receipts and statements for the plan year.

      What happens if I forget to reply to the letter requesting additional documentation?
      If you do not respond to the first request for additional information, you’ll receive a second letter. This will give you more time to respond. If you don’t reply to the second request, we will suspend your card until you send in the requested documentation or pay back the account.

      What happens if I accidentally use the TexFlex debit card for an ineligible or non-qualifying expense?
      Before using the card, you should become familiar with the list of eligible and ineligible expenses. Be sure to have merchants ring up your eligible expenses separately from your ineligible items so you can use the card. If you use the card to pay for an ineligible expense, you’ll have to pay back the account or submit a claim for another eligible expense to cover the ineligible amount.
       
      If you choose to pay back the account, you can mail a personal check to PayFlex for the ineligible amount.  Make the check payable to PayFlex.
       
      If you choose to submit a claim to cover the ineligible amount, simply send the Explanation of Benefits or detailed receipt.  You can do this online or by fax or mail.  Note: You must have incurred the expense in the same plan year and paid for the item or service out of pocket.  You cannot submit a claim for an expense which you have already been reimbursed.
       
      If you do not submit a claim or pay back the account, we will suspend the card.  Once we receive and process your documentation or repayment, your card will be active again.

      Are there any limitations on using the card?
      Yes. There are limits to when and how you can use the card.
      • You can only use your TexFlex debit card to pay for eligible items purchased from eligible merchants who accept MasterCard®.  If the merchant or provider does not accept the card, you’ll need to pay for the items with another form of payment. Then submit a claim for reimbursement.  The quickest way to get reimbursed is to submit a claim online.  Otherwise, you can complete a paper claim form and fax or mail it to us. For faster reimbursements, sign up online for Direct Deposit.  After you login to the TexFlex website, click on the Financial Center tab and select Enroll in Direct Deposit to get started. 
      • You cannot use your TexFlex debit card to pay for over-the-counter (OTC) medicines and drugs. You’ll need to get a written prescription from your doctor.  Then pay for these items with cash, check or personal credit card and submit a claim for reimbursement.  Be sure to include the receipt and written prescription when you submit your claim.
      • If your expense is greater than your available balance, your card will be declined.
      Can I use the card to pay for prior plan year expenses or a "Patient Balance Due" bill?
      No. Do not use the card in the current plan year to pay for services provided or products ordered in the prior plan year. In this case, you must file a paper claim before the deadline for the prior plan year. Also, you’ll need to submit the detailed statement, not the "balance due" statement.

      Will I receive a cardholder agreement?
      When you receive your card, we’ll include a Fund Transfer Disclosure Statement (cardholder agreement).  It’s important to read through this agreement and abide by it. By using the card, you agree to the provisions of the cardholder agreement. That is, you agree to use the card only for qualifying expenses, and to provide documentation upon request.

      Note: You’ll only receive a new card if (1) you’re new to the plan, (2) your card has expired or (3) you ordered a replacement card.  When you receive the card, read the back of your card and sign it.   Be sure to follow the activation instructions. 

      Do I have to use the TexFlex debit card?
      No. During annual enrollment, you can elect whether you want to have the card.  If you do elect the card, you still have the option to pay out-of-pocket and submit claims for reimbursement.  You can do this online or fill out a paper claim and fax or mail to PayFlex. 

      If you plan to use the card in the future, check the expiration date on the card.  The card is good for 5 years.  But don’t forget, the card does cost $15 each year.

      Will I receive a statement of my TexFlex debit card transactions?
      No. However, you can view detailed account information, including card payments on the TexFlex website.  After you log in, click on the Financial Center tab.  From the drop down menu, select the account you wish to view.  Then click on Claims or Transactions on the left side. 

      How do I report a lost or stolen card?
      Call PayFlex at (866) 353-9839 (toll free). Customer service representatives are available Monday – Friday, 7 a.m. – 7 p.m. and Saturday, 9 a.m. – 2 p.m. CT.

      What is the cost of the TexFlex debit card and how do I request one?
      Once you’re enrolled in a TexFlex account, you can sign up for a TexFlex debit card at any time by calling ERS at (877) 275-4377. The card costs $15 a year. The card fee allows you to use one card for both the health care and day care account, if you enroll in both accounts. 

      Can I order a card for my spouse or dependents?
      Yes. You can order extra TexFlex debit cards for your spouse or dependents at no cost.  You can do this on the TexFlex website.  After you log in, select Manage My Debit Card(s) under Quick Links.  Then click on Order A Dependent Debit Card and enter the first and last name of your spouse or dependent.  Please be certain that your family member fully understands how to appropriately use the card for qualifying expenses only, and that he or she keeps copies of documentation of each transaction.

      What happens if my annual health care contribution is $1,000, but I have a $1,500 expense?
      If you use your card for an amount greater than your balance, the card will be denied.  Be sure to check your available balance on the TexFlex website or PayFlex Mobile™ app throughout the year. This way you’ll know how much is available. In this example, you could ask the merchant or provider to charge only up to your available balance on the card. You would then pay the difference with another form of payment.  

      If I terminate employment, can I continue to use the TexFlex debit card?
      No. Once your employment ends, your card will be inactive. If you have eligible expenses to submit after your termination date, you can submit claims online or complete a paper claim form. (Remember, you must incur eligible expenses during the plan year, which ends on August 31).

      Activating Your TexFlex Debit Card
      If you receive a TexFlex debit card with an activation label, this means you must activate your card before you can use it. 

      How do I activate my new card?

      If you receive a new card with an activation label, call Card Services at 1-877-261-9951.  This is the same number you will see on the card activation label.  Then enter your card number followed by the # sign.  You will then enter the last four digits of your Social Security number (SSN).  If your SSN is not accepted, you may need to enter the last four digits of your Employee ID number.  Once you finish these steps, your card will be activated.  You can then use your card right away.   
       
      When can I call to activate my card?
      You can call to activate your card as soon as you receive it.  Remember, you only have to activate your card if it has an activation label on it.  To activate your card, call 1-877-261-9951.  This is the same number you will see on the card activation label.  You can call this number at any time. 
       
      After I activate my card, when can I start using it to pay for eligible expenses?
      You can use your card as soon as you activate it.  Note: You must have funds in your account to use the card.  You can view your account balance online on My Dashboard, under Financial Center – My Accounts.
       
      I previously received a card and didn’t have to activate it.  Why do I need to activate my new card?
      Before May 1, 2013, all TexFlex Cards were pre-activated.  That means that you didn’t have to activate your card before using it.  We have changed the activation process to place more security on your card and to decrease the fraud risk.  If your card has an activation label, you must call 1-877-261-9951.  You will have to activate the card before you can use it. 
       
      If I activate my card and then order a card for my spouse or dependent, do they need to activate their new card?
      No.  If your card is already active, your spouse or dependent does not need to activate their new card. This means your spouse or dependent should be able to use their card as soon as they receive it.  Note:  If the card is already active, it will not have an activation label on it.  If someone tries to activate an active card, they’ll hear this message:  “Our records indicate this account has already been activated. Please contact the customer service phone number on the back of your card if you need further assistance.” 
       
      I already have a card and did not have to activate it.  If I order a card for my spouse or dependent, do they need to activate their new card?
      No.  Your spouse or dependent does not need to activate their new card. Your spouse or dependent should be able to use the card immediately, as long as funds are available in your account.  Note: Activation is not required if the card does not have an activation label on it.
       
      If I receive a replacement card, do I need to activate it?
      Yes.  If you receive a new card with an activation label, you must activate the card before you can use it.  To activate the card, call 1-877-261-9951.  This is the same number you will see on the card activation label.  You’ll get a replacement card when your current card expires or if you report your card as lost or stolen.
       
      If I’m unsuccessful in activating my card, how many attempts can I make in a day? 
      You should not have a problem activating your card.  However, you can make two attempts to activate your card each day.  If you’re unable to activate your card after the second try, you must wait until the next day to try again. 
       
      What should I do if I have trouble activating my card or if I have more questions?
      Please call Member Services.  The number is on the back of your TexFlex debit card. 

      Personal Identification Number (PIN) for your TexFlex debit card
      How do I get a PIN for my TexFlex debit card?
      Call Card Services at 1-888-999-0121. You will be asked to enter your card number, the three-digit security code (located on the back of your card) and your five-digit zip code.  Then you must enter a new four-digit PINThis means you need to create your own PIN.  To do this, enter four digits of your choice.  To confirm your PIN, re-enter your four digits.  Once you create your PIN, you can use it right away - provided there are funds in your account. 

      Note: Please make sure to remember your PIN, as you will not receive a confirmation of your PIN. 

      Why do I need a PIN? 
      Some merchants may ask you to use your card as “debit”.  When you use your card as “debit,” you need a PIN to complete the transaction.  Also, having a PIN decreases the risk of fraudulent use of your card if it is lost or stolen.  Please note that you are not required to select “debit”; you can still use your card as “credit.”

      How do I know when a PIN is required? 
      When you swipe your card, you will be prompted if a PIN is required.  Please note that if you do not yet have a PIN, you can still use your card as “credit.” 

      When using the card, should I select “debit” or “credit”?
      If the merchant allows you to select “debit” or “credit”; either option will work.  This means you may choose “credit” and sign the receipt.  If you select “debit,” you will have to enter your PIN.  

      What if I forget my PIN?
      You can call 1-888-999-0121 to create a new PIN at any time.

      Will my spouse or dependents need a different PIN for their debit card?
      No.  There is one PIN per cardholder account.  Please make sure that any family member that has a separate debit card knows your PIN.

      What happens if I order a new card for one of my dependents and he or she calls to create a PIN?
      If your dependent calls to create a PIN, this new PIN will be the PIN for all cards on your account.  If you had already set up a PIN, that PIN will not work anymore.  When anyone creates a new PIN, it will override the PIN previously created.

      What happens if I do not have a PIN and the merchant requires that I use one?
      If you are asked to use a PIN, you can create one by calling Card Services.  The toll-free number is 1-888-999-0121.  If you do not yet have a PIN, you can still use your card as “credit.”  If you are unable to use your card as “credit,” you can pay for the eligible expense with cash, check or personal credit card.  Then submit a claim for reimbursement.  

      Can I withdraw funds at an ATM?
      No.  The card will not work at an ATM.

      Can I get cash back when using the card at a merchant?
      No.  You can only use the card to pay for eligible expenses.


      This material is for informational and educational purposes only. It does not contain legal or tax advice. You should contact your legal counsel or your tax advisor if you have any questions or if need additional information. Information is believed to be accurate as of the production date; however, it is subject to change.
  • Filing A Claim
    • How do I file an FSA claim?
      After you incur an eligible expense, you can:
      • Submit a claim online. You can upload or fax your documentation to us.
      • Submit a claim using the PayFlex Mobile® app. You can download it for free* from your mobile app store. You’ll use the same username and password that you use for this website.
      • Complete a paper claim form and mail or fax it with your documentation. You can find this form in the Resource Center.
      *Standard text messaging and other rates from your wireless carrier still apply.   

      What do I need to send with my FSA claim?
      It depends on your expense type.

      If your expense went through your medical or dental plan, you’ll need to send an Explanation of Benefits (EOB) from your plan. This is the best form of documentation.

      If your expense didn’t go through your medical or dental plan, you can send an itemized receipt or statement for the expense. It must show the:
      • Date of service or purchase
      • Amount you were required to pay
      • Description of the item or service
      • Name of the merchant or provider
      If the claim is for an over the counter (OTC) drug or medicine, you must also include a written prescription from your doctor.

      For prescriptions, send your detailed receipt. It must include the pharmacy name, patient name, prescription name, date the prescription was filled, and amount you paid.

      For dependent care expenses, the dependent care provider must sign the claim form or provide an itemized receipt. It must include the date(s) of service.

      Note: If you don’t send an EOB, itemized receipt or statement with your claim, we’ll deny it. We can’t accept a cancelled check, credit card receipt, or billing statement that shows “previous balance,” “balance forward,” “estimated,” “filed,” or “pending insurance.”