Discovery Benefits, Inc.

I am rejecting this response because: Discovery Benefits incorrectly suggests that I received notice of the 90 day termination requirement.  Within its response, Discovery Benefits admits to operating under an assumption that a third party acted to communicate the 90 days termination requirement.  It has no personal knowledge of this and therefore is making a frivolous assertion.  Further, Discovery Benefits also disclaims any corporate social responsibility for advising their clients as to when their funds will be seized.  It maintained a fiduciary responsibility to me, as an investor, and certainly failed in making even one attempt to communicate when the funds were to be forfeited.  At the very least, I am requesting that Discovery Benefits communicate with the former employer regarding making those funds (forfeited less than one week ago per their undisclosed deadline) available to me.  So far, there has only been excuses and no effort to resolve.  Thank you.

Initial Business Response /* (1000, 5, 2015/10/12) */
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's COBRA election and initial payment was received and processed by Discovery Benefits on...

July 6, 2015. According to its standard process for reinstatement, Discovery Benefits notified the carrier on July 7, 2015 of the reinstatement effective June 1, 2015. Discovery Benefits did receive confirmation that the original notification was received and opened on July 8, 2015.
The participant contacted Discovery Benefits by phone on July 22, 2015 and indicated his coverage was not active with the carrier. The Discovery Benefits' customer service representative indicated to the participant of the carrier processing time, which can take up to 15 business days.
The participant again contacted Discovery Benefits by phone on July 29, 2015 indicating his coverage was not active with the carrier. The Discovery Benefits' customer service representative advised the participant that Discovery Benefits would send another update to the carrier. Discovery Benefits received confirmation that the notification to the carrier was received and opened on July 29, 2015. The participant requested that Discovery Benefits call his carrier and when he was advised that was not a possibility, he requested a supervisor. There was no supervisor available and a call back request was created to call the participant within 24 hours (one business day).
On July 29, 2015, a representative from the participant's carrier contacted Discovery Benefits and spoke to a representative from the Carrier Relations department. The carrier representative suggested another email address but did not advise the original email address was incorrect. Another email requesting the reinstatement was sent by Discovery Benefits on July 29, 2015.
The employer sponsoring the group medical plan under which the participant was enrolled terminated the plan effective July 31, 2015. As a result, the participant's coverage was terminated effective August 1, 2015.
On August 3, 2015, Discovery Benefits sent to the carrier confirmation of coverage for this participant from June 1, 2015 to July 31, 2015. Discovery Benefits received confirmation this notification was received and opened on August 3, 2015.
The participant enrolled in the employer sponsored dependent care flexible spending account with amounts credited to the notional account each pay period. The participant did not submit any claims to the plan. On July 6, 2015, the employer notified Discovery Benefits of the plan's termination effective July 31, 2015. The employer advised Discovery Benefits that there would be no run-out period or grace period allowed for submitting claims as the business was closing.
The participant contacted Discovery Benefits on October 2, 2015 asking how to submit claims as the final filing date was showing as July 31, 2015. Since the final filing date had passed, the funds are no longer eligible for reimbursement and have been forfeited to the plan. Discovery Benefits does not retain forfeited funds.
Initial Consumer Rebuttal /* (3000, 7, 2015/10/15) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Your response shows the lack of responsibility and desire to work in good faith.
You knew the plan was terminating and you knew there was a balance. Why was there no attempt to contact me so that I could submit a claim for my funds?
When the COBRA was not active, your representative refused to even look and see if the contact information was correct or not. She claimed it was against the law. This is my information and it was verified whom I was. If they had taken the time to do their job, I would not have been without coverage for that long of a period.
It is sad that it was only corrected once Blue Cross got involved.
I do not accept your response.
Final Business Response /* (4000, 9, 2015/10/16) */
Discovery Benefits is advised of the carrier contact information upon the employer's implementation of the Plan and any time there are changes. Discovery Benefits used the contact information supplied for this carrier when updating coverage on July 7, 2015 for this member. Discovery Benefits does maintain documented confirmation of the receipt and opening of emailed notifications and can confirm the email containing this participant's information was received and opened by the carrier on July 8, 2015.
Discovery Benefits does have in place a process for urgent updates. This process is followed only after Discovery Benefits is notified by a participant that their coverage has not been updated after the expiration of 15 business days. The participant in this case contacted Discovery Benefits on July 29, 2015 at 12:41 p.m. The participant was advised Discovery Benefits would re-notify the carrier. At 12:57 p.m. on the same day, Discovery Benefits was contacted by a representative from the carrier regarding this participant. The carrier representative suggested an alternate email address to which Discovery Benefits sent an urgent update request at 1:06 p.m. on July 29, 2015.
Regarding the flexible spending account, it is the employer's responsibility to determine the run-out period allowed for the Plan and if there are changes, communicate those changes to employees. Information concerning the account was available to the participant via the online web portal and it is the participant's responsibility to monitor the status of their account balance.

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employer. Discovery Benefits does not sell directly to individuals and does not have individual service agreements with...

employees or participants.  IRS rules govern the requirements for the health FSA, including when expenses are deemed “incurred” and eligible for reimbursement during the plan year.   At no time did the customer service representative indicate that the participant could use their debit card to access the 2016 account balance or that the participant should not file expenses.  In order to provide the participant with a more detailed response, Discovery Benefits will also send a letter directly to the participant in response to the comments.

Discovery Benefits will be calling the individual so that we can explain what action is needed on the individual’s part in order for claims to be approved and reimbursement made.  We will also confirm the correct mailing address with the individual as all reimbursement checks mailed were...

returned by the Post Office as undeliverable, resulting in all claims being denied.

I am rejecting this response because:The letter I received from Discovery Benefits yesterday provided no new information.  It just reiterated the dates that my account went inactive and then got cancelled.  It included a screen shot that showed those dates.  Unfortunately, I cannot find this information anywhere in my online account.  I checked again less than an hour ago, and it still shows that I have money available.  Nothing looks out of place, except the "submit" button for sending in claims is gone, and has now been magically replaced with a note that says "No active plan available".  Every other part of the web site shows that everything is good to go.The letter did not address anything about the fact that I was not notified in any way of a major change in my account.  As I just said, my account shows nothing is amiss.  I continue to receive monthly account statements that say I have money available and my account is alive & well.  The notifications tab shows nothing out of place.If I go out and purchase a Groupon online, my money goes out into la la land.  When I use the Groupon, then I receive the benefit.  Sounds familiar.  But, the silly little Groupon sends out regular robo-emails reminding me of the end date.  As the date gets closer, I get more & more emails.  This is the 21st century.  The technology exists.  Yet Discovery Benefits did nothing to let their customer know of a major impending change in my account status.  Discovery Benefits did not do their due diligence.  Discover Benefits did not do their job.  Groupon handles people's money better than Discovery Benefits.  I should not have to pay for Discovery Benefits' lack of professionalism.Their letter says they don't keep the money "forfeited to the plan".  I don't know why they told me that.  It makes no difference to me who has the money.  The bottom line is that I don't have it, and I don't have it because Discovery Benefits make a huge error.  They owe me $519.96.  I will not be satisfied until they fulfill their duty.I don't understand how it is possible for them to have an A+ rating AND a 1.4-star average at the same time???

Initial Business Response /* (1000, 5, 2015/06/23) */
The participant filed a claim through the online portal on June 10, 2015. The documentation submitted included only a previous balance. IRS regulations require that documentation include a date of service, type of service, and dollar amount. ...

Due to the lack of required information, the claim was denied on June 11, 2015.
The participant contacted Discovery Benefits on June 11, 2015, the same day the claim was denied. The participant called several times as well on June 12, 2015, June 15, 2015, June 16, 2015 and June 17, 2015. The participant was advised to submit an explanation of benefits (EOB) so the claim could be reprocessed.
The participant submitted additional documentation on June 11, 2015 via email. The email did not include a claim number or a form so the documentation could not be processed and was put into a research status (a form or claim number is required to process any incoming documentation). During one of the calls on June 16, 2015, the claim number was provided and the claim was submitted for reprocessing.
The participant was told on June 12, 2015 that the customer service representative would have the claim approved right away. This was not accurate as customer service representatives, while they may request the reprocessing of a claim, do not have the authority to approve claims.
During a call with Discovery Benefits on June 15, 2015, the participant requested to speak with the customer service representative that advised she would approve the claim. When advised that customer services representative was not in the office, the participant requested to speak with a supervisor. Because no supervisor was available at the time, the customer service representative requested a call back number for the participant and advised that a supervisor would call him back within 24 hours. The participant indicated he would hold. The customer service representative advised that because there were other calls in queue she would not be able to allow him to hold and again advised that a supervisor would call the participant back within 24 hours. The participant again indicated that he would hold. The customer service representative again advised that there was not an option to hold for a supervisor. The participant advised that he would just wait for the customer service representative to hang up on him. The customer service representative thanked the participant for his call and ended the call.
After reviewing the most recent documentation, it was determined the claim cannot be approved because the date of service was outside of the current plan year. The plan year runs April 1, 2015 through March 31, 2016. The documentation submitted shows a December 9, 2014 date of service, which is outside the current plan year. IRS regulations require that claims must be incurred during the plan year in order to be eligible for reimbursement. All funds from the prior plan year election have been exhausted for this participant. A notice advising of the claim denial will be sent to the participant.

I am rejecting this response because:
This is an unacceptable response. Discovery benefits though they say they have been giving information to the insurance carriers, the insurance carries have not seen anything come through from discovery benefits.  Insurance carriers and discovery benefits are both saying they have done all they can.  Both of their hands are tied. They will not activiate my coverage.  Both will not reach out to the other, however, one time the insurance carrier reached out to discovery benefits and discovery benefits said they would send the necesary information, however, did not. This is unnacceptable.  Discovery Benefits has deposited my money into their acount and they don't distribute it to the insurance carriers and they don't send necesary confirmation.  This is illegal.  Revdex.com I would expect that you would not allow this as a resolution either.  If Cobra highers a 3rd party to activate and distrubute insurance from the actual carriers then that should be a trusting party.  Not a theaf.  I am forced to switch insurance coverage becuase I keep sending money in and my insurance wont get activated and medical provides refuse to see us without the active coverage or we have to pay out of pocket of the entire visit.  I paid for insurance, this is unacceptable. NOT TO MENTION, how much of my time this has taken up, especially with a brand new baby!  Please confirm this is being moved to the next steps.  Thank you.Michelle

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  In response to only one phone call they should know that their call in automated system would not allow me to leave a call back number.  I waited on hold for over 60 minutes and no one ever picked up.  While they resolved the issue their statement is false and people should know that their customer service is horrendous.  The time and energy that was put into contacting this business was a waste of time.  When will they accept accountability for their poor service and wasting their customers time?issue resolved but still a very disappointing experience with Discovery Benefits.

Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with the employer. When the participant set up his banking information on the member portal, he was provided with the following message: “In order...

for your first and subsequent recurring ACH payments to be processed, your account must be paid through the current coverage month at the time the ACH is set up. This may require you to mail a payment or make a one-time online payment. Please be sure to confirm when your ACH payments will begin before stopping other payment methods to ensure you remain current in your premium payments.”This message displayed again on the recurring payment summary page where the participant pressed “submit.” The participant did not contact Discovery Benefits or access the member portal to confirm the January 2018 payment. Discovery Benefits has responded to this participant privately as well.

Discovery Benefits is a third party administrator that provides pre-tax reimbursement account administrative services on behalf of employers pursuant to service contracts with the employer. The pre-tax reimbursement accounts are governed by IRS regulations as well as the employer’s plan document. ...

IRS regulations govern substantiation requirements for expenses paid using the benefits debit card.
The participant used his benefits debit card three times between April 13, 2015 and June 8, 2015. Receipt reminders requesting documentation for these purchases were emailed to the participant on the first day and the thirtieth day after each debit card swipe. The participant had 72 days from the date of each transaction to submit the documentation. Denial and repayment requests were emailed to the participant at that time when no documentation was received. Even though the transactions are ultimately denied due to no substantiation being received, the merchants remain paid. In accordance with IRS regulations, the participant is being required by their employer to repay the plan. The repayment is retained by the employer’s plan as forfeited funds. Discovery Benefits does not retain forfeited funds, as they are part of the employer’s plan.

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. Due to the level of detail required for a complete response, we will be send a letter directly to the participant with information concerning her account.

Discovery Benefits is a third party administrator that provides pre-tax reimbursement account administrative services on behalf of employers pursuant to service contracts with the employer. Discovery Benefits does not sell directly to individuals and does not have individual service agreements...

with employees or participants.
IRS rules govern substantiation requirements for the health FSA, including expenses paid using the debit card. Included below are excerpts from the IRS regulations governing substantiation requirements.
1.125-6(b)(2) All claims must be substantiated. As a precondition of payment or reimbursement of expenses for qualified benefits, a cafeteria plan must require substantiation in accordance with this section. Substantiating only a percentage of claims, or substantiating only claims above a certain dollar amount, fails to comply with the substantiation requirements in §1.125-1 and this section.
1.125-6(d)(7) The employer follows all of the following correction procedures for any improper payments using the debit card—
(i) Until the amount of the improper payment is recovered, the debit card must be de-activated and the employee must request payments or reimbursements of medical expenses from the health FSA through other methods (for example, by submitting receipts or invoices from a merchant or service provider showing the employee incurred a section 213(d) medical expense);
The participant used his debit card on January 6, 2016 for an expense that required substantiation under IRS regulations. On March 10, 2016, Discovery Benefits requested substantiation documentation from the participant via the email address on file. On May 8, 2016, a Denial Letter with Repayment Notice was emailed to the participant’s email address on file when no documentation was received. The denial reason was Receipt Overdue and included the verbiage: “This claim cannot be approved for processing because the necessary documentation requested in our previous notification was not received. If this is a debit card transaction, the card(s) have now been placed on a temporary hold (if applicable).”
Since no documentation has been received to substantiate this transaction, the debit card was suspended on May 10, 2016. Once this transaction is appropriately substantiated, the hold on the debit card will be lifted. Though the debit card remains on hold, the participant may continue to access funds in his account by submitting claims through the online portal or mobile app.

Initial Business Response /* (1000, 5, 2015/12/07) */
In a letter dated December 2, 2015 mailed to the participant it was explained that the reimbursement of eligible expenses is governed by the sponsoring employer's plan. The plan includes the requirement that expenses for terminated employees...

must be submitted within 90 days following the termination of employment. This information is part of the Summary Plan Description (SPD) that is provided to participants by the employer. Excerpts from the SPD were included in the letter to the participant. The final filing date is also available through the participant web portal. For this participant, claims filed after July 10, 2015 are not eligible for reimbursement based on the requirements of the plan for terminated employees. Discovery Benefits does not have discretion in this matter and must follow the employer's plan as written.
Initial Consumer Rebuttal /* (3000, 7, 2015/12/08) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Discovery Benefits is hiding behind cloudy information of the benefits plan to pocket for itself the money which was withdrawn from my paycheck. I NEVER RECEIVED ANY LETTER OR EMAIL FROM Discovery Benefits notifying me that I had 90 days from the day I rescinded my employment to file my forms to be refunded . I thank Revdex.com for trying , but it's clear that I have to contact another sphere to bring to light this improper business practice. Sometimes, all that it takes is one law abiding tax payer to change legally and civilly a dishonest business practice .
Final Business Response /* (4000, 9, 2015/12/09) */
Discovery Benefits does not retain any of the funds remaining in participants' accounts after the plan year is closed. All forfeited funds are returned to the plan. Discovery Benefits does not have discretion in this matter and must follow the plan rules as defined by the employer and IRS requirements.

The plan in which this participant is enrolled is an employer-sponsored plan governed by IRS regulations and plan rules as defined in the employer’s plan document and summary plan description.  IRS rules governing substantiation requirements for the flexible spending accounts (FSA) require that...

all claims must be substantiated, even those paid using the debit card. See 1.125-6(b)(2) and 1.125-6(3)(i).  All expenses must be substantiated by information from a third-party that is independent of the employee and the employee’s spouse and dependents. The independent third-party must provide information describing the service or product, the date of the service or sale, and the amount.Discovery Benefits received reimbursement requests from this participant that did not include complete documentation, were for ineligible expenses or were duplicate requests. Denial notifications were emailed to the participant explaining the reason for each denial and the action required by the participant for reimbursement. Discovery Benefits mails checks for reimbursement once the total reimbursement amount is equal to or greater than $25 or, if less than $25, at the end of the month.  Minimum payment amounts do not apply for reimbursements made to the participant’s account through direct deposit. Funds in an FSA may be used to reimburse eligible medical expenses only, the balance not be liquidated or cashed out.  Any funds that may remain in a participant’s account after the end of the plan year are forfeited to the employer-sponsored plan and are not retained by Discovery Benefits.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. While the issue was resolved, I continue to be upset with what I had to go through in order for it to happen.  The response stating they took care of the situation on first contact is not accurate.  The final straw was a supervisor who stated I would not be talking to anyone else and that the situation would take care of itself in a few days.  She continued to be rude even when I stated I was going to contact Revdex.com.  She was the one who left a message for me stating the issue had been resolved and she was suddenly very nice when she called.  I truly believe the situation would not have been resolved that day had I not contacted Revdex.com.

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 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 personal nature of the information included in Discovery Benefits’ response, we will respond to the participant directly via written correspondence.

I am rejecting this response because:They have not stated why this termination happened. They said they do not have access to terminate the service which is false he acause they do have access to reinstate it and if I did not pay they could certainly terminate the service. I spent too much time on he phones and had to bring my daughter to the hospital for meds due to their error, so I do not accept their response. Thank you.

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 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. Discovery Benefits notified Blue Shield CA of the reinstatement of coverage for this participant on September 21, 2017, the day after the enrollment process was completed. Discovery Benefits reached out to the carrier with urgent update requests on October 18, 2017 and again on October 30, 2018 and spoke with two different Blue Shield CA representatives on the phone on October 24, 2017 and again on November 1, 2017 to confirm eligibility for the participant.  Discovery Benefits was advised on November 14, 2017 that the participant’s coverage was being updated by a consultant working on behalf of the employer. Upon receipt of confirmation of the update, Discovery Benefits’ customer service will contact the participant to let him know.

I am rejecting this response because:
This is the canned response to all similar complaints I have read. They just fill in the blanks with the specific dates.It was probably my former employer's error in stating my last day was 11/23 even though I submitted a timesheet through 11/25. But that does not excuse the fact that DiscoveryBenefits intentionally chooses to remain silent with the intent to gain from "forfeited" funds that are rightly owed to the consumer. And as I stated in the original complaint, the excuse that the consumer is advised of this 30 period when he/she is hired is just "passing the buck" of responsibility.

I am rejecting this response because: Discovery Benefits did not respond to my chief complaint, which was that I was told I could substitute a valid claim for claims that were not reimbursed but deducted early on in the plan period due to card use with no invoice.  I have had another flex plan for over 5 years with ZERO issues.  Discovery Benefits has been very difficult to deal with.  On another note, their response does not comply with the law and mistakes the IRS code.