How to file a claim

Claims for eligible expenses should be filed with the claims administrator
control room

After you incur an eligible expense, you can file a claim for reimbursement from the HCFSA and/or the DCSA anytime during the plan year in which you incur the expense.

An expense is incurred on the date the service is provided, not the date you are billed or you make payment. If you enroll midyear, you may be reimbursed only for expenses incurred after the date you begin participating.

Deadline for filing claims

You have up to 90 days after the end of the plan year to submit completed claim forms and attachments to PayFlex for reimbursement. This can be by fax or by mail (see Administrative information for the phone number and address).

Be sure to keep a copy of the claim form and any attachments for your personal records. Your claim form must be faxed or postmarked by June 30, or you will forfeit any remaining contributions in the HCFSA and/or DCSA due to the “use it or lose it” rule.

Reimbursement process

There are several ways in which you can submit your claim for reimbursement or have providers reimbursed directly from PayFlex:

  • Online. To file your claim online, upload your documentation (receipts, Explanation of Benefits) in the form of PDFs through the PayFlex site, My Dashboard, at www.aetna.com. You can use your Aetna login information to access the features on this site. You can choose to be reimbursed directly ("Pay Me") or have your provider be reimbursed directly ("Pay Them") through this feature.
  • By mail or fax. You can also complete a paper claim form (available through the PayFlex site at www.aetna.com) and fax your claim and documentation to 1-888-238-3539 or 1-888-AET-FLEX, or mail them to the following address:
Aetna Inc.
P.O. Box 4000
Richmond, KY 40476-4000
 You can receive your reimbursement in one of the following ways from PayFlex:
  • By direct deposit. Direct deposit allows you to have payments for claims submitted online or by mail deposited directly into your checking or savings account. Go to the PayFlex site, My Dashboard, at www.aetna.com to sign up for direct deposit.
  • By check to you. Generally, within two weeks after receiving your online reimbursement request or claim form, PayFlex will send a reimbursement check directly to your address of record if you have not set up direct deposit.
  • By payment directly to your provider. If you applied for reimbursement online and selected the "Pay Them" option on the PayFlex site (My Dashboard at www.aetna.com) using the process described above, your spending account reimbursement will be sent directly to your provider.

HCFSA claims

To be reimbursed from your HCFSA, 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 HCFSA claim form or file for reimbursement online.

When you file for reimbursement online, via fax or via mail, you will need to include 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 HCFSA 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 HCFSA.

Streamline HCFSA reimbursement

Streamline reimbursement is not available for reimbursements from HMOs, the BP Vision Plan or from the Dental Health Maintenance Organization (DHMO). It’s also not available if you are covering a domestic partner or a domestic partner’s child in your BP Medical Plan or BP Dental Plan coverage.

If you enroll in the HCFSA and you participate in the HealthPlus or Standard Option — 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 30 days of your date of hire, you'll need to contact Aetna to add this feature.) Under this program, Aetna processes your HCFSA claims automatically.

Here is how the program works for your claims processed by Aetna/PayFlex as claims administrator under the BP Medical Plan:

  1. Aetna/PayFlex receives a claim — either from the provider directly or from you.
  2. Aetna/PayFlex 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).
  3. Based on your out-of-pocket expenses, Aetna/PayFlex determines the amount eligible to be reimbursed from your HCFSA.
  4. Aetna/PayFlex automatically reimburses you for your out-of-pocket expenses.

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/PayFlex then determines the amount eligible to be reimbursed from your HCFSA, 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're covering a domestic partner, who isn't your dependent for federal income tax purposes, under your health care plan.
  • 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 HCFSA claims yourself, you should cancel your Streamline participation by logging on to the Aetna website. Once Streamline is cancelled, you will need to manually submit online, mail or fax claims for reimbursement of your eligible health care expenses.

Remember, the Streamline reimbursement option stays in effect for the entire plan year.

DCSA claims

To be reimbursed from the DCSA, you must complete a DCSA claim form online or via mail or fax. You can file a claim through the PayFlex site, My Dashboard, at www.aetna.com.

The IRS requires that the claim form indicate:

  • The type of service provided.
  • The date the service was provided and the expense was incurred.
  • The name of the eligible dependent for whom the service was provided.
  • The name, address and taxpayer identification or Social Security number of your dependent care provider.

When you file a claim for an eligible dependent care expense, you will be reimbursed only up to the amount you have accumulated in the DCSA as of the date the claim is processed.

Account information

You may access your personal benefits information online anytime through the PayFlex site, My Dashboard, at www.aetna.com. Through this site, you can:

  • Retrieve complete account information, such as your current balance, claim history and dates of payment.
  • Verify payment information or check the status of your claims.

 

Publication date: April 2018

 

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