Discovery Benefits, Inc.

The termination date for the participant was supplied to Discovery Benefits by his former employerThe funds remaining in the account were not eligible to be carried over into the plan year. Any funds remaining after the final filing date have been forfeited to the employer’s plan and no further reimbursement can be made to the participantDiscovery Benefits does not retain any forfeited funds

Initial Business Response /* (1000, 5, 2015/07/21) */
Upon review of the documentation related to this complaint, Discovery Benefits agrees that the Benefits Termination Form provided to and completed by the participant was confusing when used to terminate coverage on a mid-month basis (in this
case through May 8, 2015)Discovery Benefits will work directly with the participant to collect the premium owed and reinstate the coverage according to the original request
Initial Consumer Rebuttal /* (2000, 7, 2015/07/22) */
(The consumer indicated he/she ACCEPTED the response from the business.)
We are accepting this response because Discovery has agreed to accept our premium payment and restore benefit coverage from May 1, - May 8,

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance
carriers. According to its standard process for communicating eligibility with carriers, Discovery Benefits notified the carriers of the reinstatement of coverage for this participant on December 6, Discovery Benefits sent urgent update requests to the dental and vision carrier for this participant on December 14, 2017, January 15, and January 19, 2018. Discovery Benefits received confirmation of the reinstatement of dental coverage for this participant on January 22, and continues to work with the vision carrier for confirmation of the vision coverageDiscovery Benefits will reach out to the participant by phone upon confirmation of the reinstatement of vision coverage

I am rejecting this response because: They have given me no reason to believe that the payment was improperThe information they have indicates that the provider is an ALLERGIST! I challenge them to give me an example of an expense from an ALLERGIST that would NOT not be covered under the IRS definitionsThe lack of POS data from the provider does not by itself , make the payment improperFurther, they have not contacted me about this as requestedLet me reiterate that this is my money and not theirsI find their recalcitrance on this point infuriatingThis literally NEVER happened under their predecessor Continuon Benefits Services

I am rejecting this response because:
They did not address the problem

Initial Business Response /* (1000, 5, 2015/10/22) */
IRS rules govern substantiation requirements for the health FSA, including expenses paid using the debit card
The participant used her debit card to pay for a service on February 13, Due to IRS regulations, documentation was required
for this claim to be approved
The participant submitted documentation on February 19, A portion of the claim was denied as being covered by insurance
The participant submitted further documentation on February 27, The dates of service and amounts were not included on the documentation
The participant submitted documentation again on March 26, The documentation was not legible and the expense type or amount could not be determined
The documentation was resubmitted on April 15, The claim was denied in error on April 16,
Due to the close of the plan year, Discovery Benefits has notified the employer the amount of $is an eligible expense and should not be considered a taxable event
Initial Consumer Rebuttal /* (3000, 7, 2015/10/22) */
(The consumer indicated he/she DID NOT accept the response from the business.)
That information was also faxed twice by myself and once on 2/13/by Blue CrossWe faxed due to the downloads not being clearWhat happened to those faxes? As stated prior they had staff members expecting the Blue Cross fax after a way phone conversation and both failed to submit the faxesAs a consumer I don't feel I should pay due to the incompetence of their staff
Final Consumer Response /* (3000, 11, 2015/10/29) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Please have them address employee error stated in my last summaryYes the pictures I took of the EOB were not clear therefore Blue Cross faxed to employees Val and Amanda on 2/13/I also faxed more times all had the Claim number clearly written
Final Business Response /* (4000, 13, 2015/10/30) */
The error referenced was corrected by notifying the employer not to tax the participant on the outstanding amount that required documentationThe merchant remains paid for the expenses incurredThe participant was made whole as if the error had not occurredThere is no additional action that can or will be taken

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with
employees or participants Discovery Benefits charges a $per month service fee for individual accounts once the accounts are no longer associated with an employerThis information is available under the Terms and Conditions the employer provided to the participant upon HSA enrollmentDue to an administrative oversight, the fee was not collected for until August when the oversight was discovered The service fees for January through September were collected in August and September 2017. Discovery Benefits emailed the participant with an explanation of the service fee on September 11,

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees, participants
or qualified beneficiaries Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers. On October 3, 2017, the first day after the enrollment was completed, Discovery Benefits notified each of the carriers of the reinstatement of all coverage elected to be effective September 1, 2017.Discovery Benefits has been advised by many carriers of an industry standard of two to fifteen business days processing time for reinstatementAs Discovery Benefits does not have control over the carrier’s records, this information is provided to participants upon request. After receiving a phone call from the participant indicating her coverage was not active with the carrier, Discovery Benefits submitted an urgent update request to the carrier for this participant on October 23, 2017. On October 23, Discovery Benefits received confirmation of the reinstatement of dental coverage for this participant effective September 1, On October 26, Discovery Benefits received confirmation from the carriers of the reinstatement of medical and vision coverage for this participant effective September 1,

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employer. Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance
carriers. The participant elected COBRA and made their initial premium payment on October 9, Discovery Benefits notified the carriers of the reinstatement of coverage effective August 26, on October 10, 2017.Discovery Benefits processed annual plan and rate changes effective January 1, on behalf of this participant’s former employer on November 7, Each of the carriers for this participant were provided notification from Discovery Benefits on November 8, 2017. Discovery Benefits reached out to each of the carriers for this participant again on January 10, and received confirmation of coverage effective January 1, on January 10,

Initial Business Response /* (1000, 5, 2016/02/10) */
Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have
individual service agreements with employees, participants or qualified beneficiaries
In its role as a third party administrator, Discovery Benefits generally acts on instructions from employers, qualified beneficiaries, and/or insurance carriersDiscovery Benefits (i) is not an insurer or an insurance carrier and (ii) does not have control over the records or assets of an insurance carrier
Discovery Benefits processed the annual renewal for the client's plan under which the participant is coveredThe client offered a 14-day open enrollment period during which the participant was required to complete, sign and return an open enrollment form indicating future coverage and future coverage levels
Discovery Benefits received the open enrollment form from the participant on December 1, and processed the changes to his record on December 3, On December 3, 2015, Discovery Benefits notified the carriers of the addition of the "new" benefits for this participant effective January 1, Discovery Benefits has been advised by several carriers that it may take between and business days for coverage to be updated
On January 11, 2016, Discovery Benefits notified the carriers of the termination of the participant's "old" benefits effective January 1,
On February 1, 2016, Discovery Benefits received from the medical and vision carriers email confirmation of the participant's reinstatement of coverage effective January 1,
On February 9, 2016, Discovery Benefits received confirmation of the update of dental coverage effective January 1,

The participant web portal contains the final service date and the final filing date at all times This information is readily available for participants to monitor as they experience changes in status The 90-day runout period from the date last active in the plan is what was communicated to DBI by the employer and would be included in the SPD which is required to be provided to employees by an employer. We have been in communication with the employer regarding this participant The employer will allow a one-time exception for this participant We will reprocess the claim submitted by the participant and will communicate directly with the individual on any follrequired

I am rejecting this response because: they have not identified any actions they will take to ensure this does not happen again. Think about driving around knowing you have paid your insurance premium. An automobile accident occurs and you show up at the hospital and find out the coverage is not active - even though it should be. I want assurance they are finding out the root cause and correcting it. Their response is not accepting their responsibility. My background is technology - and this tells me there is something broken in the process between Discovery Benefits and United Healthcare. It needs to be resolved

Debit card purchases recognize the date the card is swiped as the date of serviceThe participant used her debit card on March 23, The final service date for the plan year was March 15, These circumstances required the full amount of the purchase to be pulled from the current
(2016) plan year
In addition, single debit card transactions cannot be split between plan years because payment history of partial claims cannot be transferred from one year to another
The participant submitted documentation for a portion of the claim on April 25, The date of service on the documentation was February 5, so the amount was approved from the plan yearThe remaining amount was denied on April 26, because no documentation was providedA denial email notification was sent to the participant advising of the denied portion of the claim and the reason
On May 3, 2016, the merchant refunded the participant’s debit card for the full amount of the claimAs a result, the full claim has been substantiated and no further documentation or repayment is required
The participant’s last day to file a claim for the plan year was April 30, There were no additional claims filed

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with employees, participants
or qualified beneficiaries. Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers. Due to the amount of personal information required for a complete response, Discovery Benefits will send a letter directly to the participant and not respond through the Revdex.com

Initial Business Response /* (1000, 5, 2016/02/25) */
Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits does not sell directly to individuals and does not have
individual service agreements with employees, participants or qualified beneficiariesDiscovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers
The participant enrolled and paid her initial premium (for November 2015) online on December 6, According to its standard process, Discovery Benefits notified the carrier of the reinstatement of benefits effective November 1, on December 8,
Discovery Benefits was notified by the participant on January 13, that her coverage was reinstated effective December 1, rather than November 1, Discovery Benefits reached out to the appropriate carrier contact on January 18, to confirm continuous coverage
Discovery Benefits again reached out to the appropriate carrier contact on February 1, to confirm coverage for November Discovery Benefits received confirmation from the carrier contact on February 1, of the reinstatement of coverage for November
The participant contacted Discovery Benefits on February 11, and again on February 17, advising her coverage was not active for November Discovery Benefits again reached out to the carrier contact to confirm coverage for November
Discovery Benefits did not receive the participant's December premium within the grace period allowed and her coverage was terminated effective November 30, Discovery Benefits notified the carrier contact of the termination of the participant's coverage effective December 1, on December 14,
Discovery Benefits was advised on February 25, by the participant's former employer that they too have been working with the participant in this regard

I am rejecting this response because:I've read other complaints posted on the Revdex.com websiteRealizing what your response would likely be, I decided to contact my former employerThey were HORRIFIED to know that this was the policy--as my HR director was even unawareIt was never their intentions for this to be the caseShe thanked me for getting in touch so that she could contact Discovery Benefits and make a change so that this would never affect an employee leaving there againSo that tells me that no only was I not well informed, your representatives do not do a good job of informing the companies that use your serviceIt was explained to me when I called and it was too late, where I should have looked for the informationHowever, not being aware that you had a deadline, I was not looking for the information. You need to amend your policies to actually be helpful to your customers and their employeesGiven that this information "was available" yet hidden, it seems like a bad business practiceIf my employer was not even aware, how would you expect me as an employee to be aware? I even reviewed my enrollment as I had to provide a screen shot for my employerIt is not clear to me in that information either that I had a deadline if I left early. My former employer is a wonderful companyThe HR director has assured me that one way or another, I will received my fundsBut I truly think you should evaluate your practices as a companyI've never had the displeasure of working with a company that was so sneaky in how they posted noticesAgain, every other benefit I have made it very clear to me in writing that I would have "XX days" to file this or thatBut not Discovery BenefitsAnd I guess I should state for the record that my claims were within the time I worked at my former job, I just had not filed to collect my reimbursement

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employerDiscovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance
carriers. The participant’s COBRA continuation was terminated effective October 31, due to an insufficient premium paymentUpon authorization from the former employer, a one-time exception for a late payment was allowed and COBRA continuation reinstated for November 2017.This participant’s federal COBRA continuation period expired on November 30, There is no opportunity to continue under this group health plan We recommend the participant contact the carrier for other coverage options that may be available to them.All required notices have been sent to the participant and the carrier and any payments received from the participant after the expiration of COBRA have been destroyed and the participant notified

I am rejecting this response because:
I have tried numerous times (more than 7) to contact this businessI’ve done it via telephone, email, and in writing and they gave yet to reply/respond backThe business said they will respond in writing rather than through the Revdex.com because they do not plan on responding!

I am rejecting this response because:
Those dates are incorrect I wasn't even done working with that employer until after the 3rd So the last date of filing should be after that, also HR told me any balance under $would roll over and I would be able to use it as my own card before the end of the following yearI request that my money be released back to me to use on my own prescriptions as soon as possibleIf you say you don't have any of my prescription money then who has it? Please correct this issue to resolve all matters

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that they have given a very generic answer and I still feel that they are not handling the situation correctly, but I will let my employer deal with them directly as they have put a few thousand in our account and still have trouble with themIn June (with a life changing event) I will discontinue services with this company and it sounds as if my employer is looking into other options as wellIt is unfortunate that this company has so many negative reviews and do not seem to careThank you for your time