HCSA claims
To be reimbursed from your HCSA, if the expense is covered under your medical, dental or vision plan, you must first file a claim with the relevant plan. Once you receive an explanation of benefits (EOB) from your medical, dental or vision plan indicating the portion of the expense not covered by the plan, complete an HCSA claim form. You can download forms from the LifeBenefits site.
In addition to the completed claim form, you will need to attach the Explanation of Benefits (EOB) or the original receipt, which must include:
- The name of the person or organization providing the service or product.
- The type of service or product provided.
- The date the service was performed and the expense was incurred.
- The name of the covered person for whom the service or product was provided.
When you file a claim for an eligible health care expense, you will be reimbursed for the full amount of the claim whether or not you have accumulated enough contributions in the HCSA to cover that expense as of that date, as long as your total claims submitted do not exceed the annual amount you elected to contribute to the HCSA.
Streamline HCSA reimbursement
Streamline reimbursement is not available for reimbursements from HMOs, the Behavioral Health Services Program administered by CIGNA Behavioral Health, the BP Vision Plan or from the Dental Health Maintenance Organization (DHMO).
If you enroll in the HCSA and you participate in the BP Medical Plan — or if you are enrolled in the BP Dental Plan — you are automatically enrolled in Aetna’s Streamline reimbursement program if you elect to participate in a spending account during annual enrollment. (If you're a new hire and elect to participate within 45 days of your date of hire, you'll need to contact Aetna to add this feature.) Under this program, Aetna processes your HCSA claims automatically.
Here is how the program works for your claims processed by Aetna as claims administrator under the BP Medical Plan:
- Aetna receives a claim — either from the provider directly or from you.
- Aetna determines the benefits payable under the BP Medical Plan and the amount for which you are responsible (your out-of-pocket expenses such as copays, deductibles and/or coinsurance).
- Based on your out-of-pocket expenses, Aetna determines the amount eligible to be reimbursed from your HCSA.
- Aetna automatically reimburses you for your out-of-pocket expenses once they reach $10.
To facilitate automated reimbursement of your expenses under the BP Medical Plan’s Prescription Drug Program administered by Express Scripts and expenses under the BP Dental Plan administered by MetLife, Aetna has established electronic feeds of the prescription and dental expense claims incurred by you or your covered dependents under the BP Medical Plan or BP Dental Plan. Aetna determines the amount eligible to be reimbursed from your HCSA, and processes these amounts just like your eligible medical expenses.
You may not want to select the Streamline feature if:
- You and/or your dependent also have coverage under another health plan and coordination of benefits applies.
- You are covering a domestic partner under your health care plan who is not your dependent for federal income tax purposes.
- You have access to a spending account through your spouse’s plan.
If these circumstances apply to you, or if you prefer to submit your HCSA claims yourself, you should cancel your Streamline participation by logging on to the Aetna Navigator site. Once Streamline is cancelled, you will need to use your HCSA Debit Card and/or submit paper claims for reimbursement of your eligible health care expenses.
HCSA Debit Card
The HCSA Debit Card allows you to pay for eligible medical, prescription, dental and vision expenses by charging the eligible expenses directly against the available balance in your HCSA. For example, you can use the Debit Card to purchase prescription drugs and certain over-the-counter supplies (but not over-the-counter medications) at eligible merchants — that is, those supermarkets, pharmacies, discount chains and wholesale clubs that are “certified” (approved) by Aetna. To see a list of certified merchants, go to www.aetnafsa.com.
To use your Debit Card:
- You must have enough money in your HCSA to cover the entire expense.
- You don’t have a personal identification number (PIN), so when given the option between debit and credit, choose credit.
- Always sign a receipt* and keep your copy. The IRS requires that you retain actual receipts to document that an expense is FSA-eligible.
- You can use your card only at certified and registered locations (i.e., participating health care merchants and providers).
- You cannot use the HCSA Debit Card to get cash from an ATM or to purchase over-the-counter non-prescription drugs.
Once issued, your HCSA Debit Cards will be valid for three years. You can manage your Debit Card account online through Aetna’s Debit Card lookup tool. You can also contact Aetna FSA Customer Service at the number on the back of your Debit Card.
* If Aetna determines that your charge may need further substantiation, you will be notified in writing requesting the receipt and/or supporting documentation to validate the claim. Failure to validate the claim may result in the issuance of a 1099 for the amount of the unsubstantiated claim.