Section 125 (FSA)
Participant
Communications Guide
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Section 125 Participant Communications Guide
TABLE OF CONTENTS
INTRODUCTION ........................................................................................................... 1
Additional Section 125 Resources Available .....................................................................................1
Other Resources Available ................................................................................................................1
PARTICIPANT COMMUNICATIONS ............................................................................ 2
Enrollment Materials ..........................................................................................................................2
Enrollment Brochure .....................................................................................................................2
Posters .........................................................................................................................................2
Flyers/ Payroll Stuffers .................................................................................................................2
These stuffers are used to advertise your plan ............................................................................2
More tools .....................................................................................................................................2
PARTICIPANT ACCOUNT INFORMATION.................................................................. 3
Participant Account Correspondence ................................................................................................3
Enrollment Confirmation ...............................................................................................................3
Receipt Request Reminder Statement .........................................................................................3
Participant Account Balance Reminder Notice .............................................................................3
Claim Process and Payments notification ..........................................................................................3
Claims Processed but not yet paid ...............................................................................................3
Reimbursement Check .................................................................................................................3
Direct Deposits .............................................................................................................................3
Claim Follow-up Notice .................................................................................................................3
Flexible Benefits Card swipes ............................................................................................................4
Payment Card Transaction ...........................................................................................................4
Payment Card Declines ................................................................................................................4
Flexible Benefits Card swipes ............................................................................................................4
Payment Card Transaction ...........................................................................................................4
Other Account functions and information available ............................................................................4
ADMINISTRATIVE FORM DESCRIPTIONS ................................................................ 6
Client Administrative Forms ...............................................................................................................6
Enrollment Brochure .....................................................................................................................6
Participant Forms ...............................................................................................................................6
Spending Account Claim Form .....................................................................................................6
Direct Deposit Authorization Form ................................................................................................6
Change of Address Notification Form ...........................................................................................7
APPENDIX A – PARTICIPANT COMMUNICATION ..................................................... 8
APPENDIX B – PARTICIPANT CORRESPONDENCE .............................................. 12
APPENDIX C – ADMINISTRATIVE FORMS .............................................................. 15
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Section 125 Participant Communications Guide
INTRODUCTION
This “Section 125 Participant Communications Guide” is designed to provide you with details on your
Flexible Spending Account participant materials that are available for distribution.
The following resources are also available to support the administrative and communication needs of
your program administered by us.
Additional Section 125 Resources Available
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Section 125 Administration Guide – Provides details for on-going administration duties.
Section 125 Client Communications and Reports Guide – Provides details and examples
of available client communications and reports.
Data Submission Guide – Provides details on the available methods of reporting data.
Other Resources Available
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HIPAA Summary Guide – Provides details on HIPAA compliance.
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Section 125 Participant Communications Guide
PARTICIPANT COMMUNICATIONS
(See Appendix A for examples of participant communications.)
Enrollment Materials
The following outline our take care® program, proven to deliver clear consumer oriented information
and to increase participation in the plan. Participant communication materials are always available
on our website and are free of charge.
Enrollment Brochure
The take care Enrollment Brochure explains the Flexible Spending Account program, assists the
employee in planning their participation, answers frequently asked questions and includes a tear off
enrollment form. Everything they need to make their participation experience easy and positive.
We have several brochure options to meet your needs. All are available in printed form as well as an
pdf document. The tear off enrollment form gathers the necessary data to populate our
administrative system.
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Take care Enrollment Brochure with Flexible Benefits Card
Take care Enrollment Brochure with additional benefit options
Take care Enrollment Brochure plus integrated HSA Account
Take care Enrollment Brochure without card
Posters
The following posters are a great way to promote your plan.
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Save 25-40% on Family’s Medicines
Save 25-40% on Doctor’s visits
Save 25-40% on Day Care
Save 25-40% on Expenses Your Health Plan Doesn’t Pay
Flyers/ Payroll Stuffers
These stuffers are used to advertise your plan
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Save 25-40% on Expenses Your Health Plan Doesn’t Pay
Save 25-40% on non-prescription items
More tools
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Mytakecareplan.com web site with savings calculator
Employee video
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PARTICIPANT ACCOUNT INFORMATION
Our goal is to provide the information participants need when they need it. Consequently, there is a
wealth of information available 24x7 on our secure participant web site. However, when
correspondence is necessary, we use postal mail as the most reliable method of delivering
information. Web site or email access is not required to effectively participate in the plan.
The various participant correspondences that we provide to participants are outlined below.
Participant Account Correspondence
Enrollment Confirmation
Participants receive an enrollment confirmation via postal mail to let them know that their enrollment
was received and updated in our system. See Appendix B.1.
Receipt Request Reminder Statement
Each month, participants receive a statement of the debit card swipes which we are requesting to
verify their receipts. A statement is sent only if the participant has nay remaining card swipes for
which additional receipts must be submitted. See Appendix B.2.
Participant Account Balance Reminder Notice
60 days prior to the end of the plan year, each participant with a balance of more than $10 receives a
letter reminding them to use their funds for qualified expenses before the plan year end date,
including the applicable ending date for claims submission. See Appendix B.2.
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Claim Process and Payments notification
Claims Processed but not yet paid
Claims processed but not paid are shown on the secure participant web site.
Reimbursement Check
Claims paid are shown on the secure participant web site.
Direct Deposits
Direct deposit payments are shown on the secure participant web site.
Claim Follow-up Notice
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The participant receives a letter detailing the reasons for any submitted claim amount which was
denied.
Flexible Benefits Card swipes
Payment Card Transaction
When a participant uses their payment card, the transaction is immediately shown on the secure
participant web site.
Payment Card Declines
If a participant attempts to use their payment card and is declined, the transaction is immediately
available on the secure participant web site along with the specific reason for the decline.
Flexible Benefits Card swipes
Payment Card Transaction
When a participant uses their payment card, the transaction is immediately shown on the secure
participant web site.
Other Account functions and information available
Account Balance
Account balance and summary information is shown on the landing page of the secure participant
web site. The most frequently asked question is also the quickest to answer. The information is also
available via the phone from our Interactive Voice Response (IVR) system 24x7.
Request a payment
The participant can create a claim online to request payment at the secure participant web site, print
and fax/mail/email the claim along with supporting receipts/documentation. Of course, they can also
submit a paper claim form.
Request extra cards
The participant can request additional cards at the secure participant web site. There is no charge for
extra cards.
Pending payments
Claims or swipes in process are shown on the secure participant web site
Completed payments
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All completed payments (claims or card swipes) are shown on the secure participant web site.
Review card payments
All card swipes which we are asking for receipts are shown on the secure participant web site. The
participant can also create the receipt verification form online, for easy submission of receipts for
verification.
Repay non-qualified expenses online
If the participant swipes the card and receipts are required, but they don’t have them, they must repay
the plan. This repayment can be accomplished on the secure participant web site with standard
credit card payment.
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ADMINISTRATIVE FORM DESCRIPTIONS
Included in this Guide are several forms with which you will need to be familiar. They are described
here for your reference and are readily available on our secure employer website.
Client Administrative Forms
Administrative forms are those that you, the Plan Administrator, will use to gather information from
your employees and then transmit to us.
Enrollment Brochure
The Enrollment Brochure/ form is used to manually notify us of participants who will be making a new
election. Terminating or changing a participant’s information can also be done by by entering the
change online on the secure employer web site or by sending us a data file.
Participant Forms
The following are forms that may be completed by the participant during the plan year.
Spending Account Claim Form
Each expense that is submitted to the Spending Account for reimbursement must be substantiated by
documentation. The IRS requires 100% substantiation of each expense, even when the payment
card is used to pay for the expense. The participant can directly enter their claim online through a
web claim entry screen, print their claim form and fax along with his receipts or substantiation to us
for final adjudication.
“Substantiation” is defined as receipts (canceled checks, check carbons or balance forward
statements are not acceptable) or Explanation of Benefit statements submitted with the claim form,
which must show date(s) of service, description of service or product purchased, who incurred the
expense and the amount of the service or product.
The claim form must be signed by the participant and can be faxed, mailed or emailed directly to us
for claim adjudication. We prefer participants to email or fax their claims to us at 913-234-1111. We
scan all claims and receipts so if a participant sends a claim via US mail, we ask that small receipts
such as prescription receipts, be taped to an 8 ½ x 11 piece of white paper to assist in scanning the
receipts quickly.
If an employee drops his claims off to you, be aware that the claim may contain private health
information (PHI) and encourage the employee to send the claim directly to us. That helps take the
administrative burden off you, as well as, comply with HIPAA regulations.
Direct Deposit Authorization Form
A direct deposit form is included with each paper check to encourage your employees to participate
and get the many advantages offered by direct deposit. The participant can forward this form directly
to us and have their next claim reimbursement directly deposited into their checking account.
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Change of Address Notification Form
If you are advised of an address change for a Spending Account participant, be sure to forward the
new address to us, or better yet, enter it online at the secure employer web site. In addition, a
participant has the opportunity to up date their new address on the secure participant web site and
you will be notified via email to confirm. You, as the employer, can also forward the address changes
via your electronic file submission or enter the change online at the secure employer website.
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APPENDIX A – PARTICIPANT COMMUNICATION
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APPENDIX B – PARTICIPANT CORRESPONDENCE
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APPENDIX C – ADMINISTRATIVE FORMS
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