Discovery Benefits, Inc.

Discovery Benefits is not the carrier and does not have access to carrier systems and does not control the records of the carrier which is why we are unable to confirm the cause of the termination As stated in our earlier response, Discovery Benefits did not at any time advise the carrier to end coverage for the dependents of the participant

Initial Business Response /* (1000, 5, 2015/09/28) */
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 received the participant's plan elections and initial premium payment on May 11,
Discovery Benefits provided reinstatement information for the participant's dental and vision coverage to the appropriate contact on May 12,
Discovery Benefits reached out to the contact on June 2, to confirm the reinstatement of dental benefits for the participantUpon receipt of confirmation of coverage on June 9, 2015, Discovery Benefits communicated this information to the participant
The participant contacted Discovery Benefits on September 4, about concerns with the reinstatement of his vision coverageDiscovery Benefits reached out to the appropriate contact again to confirm coverage was reinstated
Discovery Benefits received verbal confirmation on September 25, of the reinstatement of the vision coverage for the participantA Discovery Benefits customer service representative left a voice mail message for the participant to return a call to Discovery Benefits and according to a voice message left for Discovery Benefits, the participant confirmed vision coverage is now active
Initial Consumer Rebuttal /* (2000, 7, 2015/09/29) */
(The consumer indicated he/she ACCEPTED the response from the business.)
You will note the dates of coverage reinstatement for dental and visionI had been paying monthly for coverage since April It took until June 9th for dental and September 25th for visionI placed numerous calls to Discovery Benefits, who was collecting my money all the time, they were not helpful or friendlyI think it is Discovery Benefits responsibility to verify my coverage with the insurance providerThey did not, it took numerous calls to my company, and the insurance providers to contact Discovery Benefits to verify coverageTo my knowledge Discovery Benefits made no effort to contact anyone on my behalf all the while taking my moneyAnd they were not helpful or friendlyI think Discovery Benefits needs to ensure that providers receive and confirm receipt of Discovery Benefits notices to themI spent far too many hours on the phone and on hold trying to resolve what should have been a simple procedural process

Initial Business Response /* (1000, 5, 2016/03/03) */
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
Discovery Benefits received the participant's information via file from the client's file vendor and loaded this participant's information to its system on January 4, Discovery Benefits mailed the appropriate notifications to the address on file for this participant on January 5,
According to its agreement with the client, on January 5, Discovery Benefits notified the third party responsible to update the carrier of the reinstatement of benefits for this participant effective January 1,
The participant called Discovery Benefits on January 13, 2016, advised of a correction to her date of birth, and indicated her address was incorrectShe was advised to complete the appropriate change of address form and how to obtain the form
Discovery Benefits received the completed address change form from the participant on January 28, and made the address correction to its system on February 2,
Discovery Benefits received and processed the completed authorization form for automated payments from the participant on February 9,
The participant contacted Discovery Benefits on February 12, to advise her coverage was not activeOn February 17, 2016, Discovery Benefits advised that the third party responsible to update the carrier had been sent an updated file and processing time should be allowed
Discovery Benefits participated in three calls with the insurance carrier from February 17, to February 29, regarding this participant's coverage
On March 2, 2016, Discovery Benefits received confirmation from the third party responsible to update the carrier of the reinstatement of benefits for this participant effective January 1,
It is unclear what the participant means by the website being "broken." The participant has logged in several times in the past few months, most recently on February 26, 2016, February 29, and March 2, If the participant is finding the portal to work differently than expected she should contact Discovery Benefits so we can research the issue with her
Initial Consumer Rebuttal /* (2000, 7, 2016/03/04) */
(The consumer indicated he/she ACCEPTED the response from the business.)
It is now March and my enrollment information has finally made it to the insurance companyThis is due to intervention on my behalf by Cypress Semiconductor, and not Discovery Benefits

Notice is provided through the online HSA terms and conditions (custodial agreement and disclosure statement). The monthly fees should have been deducted each month and due to an administrative error, were delayed. Fees are now being deducted on the regular monthly schedule. If the participant wishes to transfer their HSA to another custodian, we recommend she contact Discovery Benefits so we can explain the process for doing so

Discovery Benefits stands by the information provided in its earlier response As stated earlier, Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers. Carrier notifications go to a contact or department at the carrier specified to us by the employer and carrier Carriers have advised that it can take up to days for a carrier to update its records Often carrier customer service representatives are not aware documentation has been received because the carrier does not yet have their systems updated As soon as we receive confirmation from the medical carrier that their systems have been updated, we will reach out to the individual letting him know

On May 3, 2016, the merchant refunded the participant’s debit card for the full amount of the expenseAs a result, the funds were returned to the FSA and no further documentation or repayment is required for that transactionThe final date to file claims for the plan year was April 30, No other expenses were filed by the final filing date and in accordance with the employer’s plan, the plan document and IRS rules, Discovery Benefits is unable to provide a refund

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, Discovery Benefits notified the carriers of the reinstatement of this participant’s coverage on October 11,
Discovery Benefits reached out to each of the carriers for confirmation of coverage when notified by the participant on November 2, that his coverage was not active
Discovery Benefits received confirmation from each of the carriers on November 16, of the reinstatement of coverage for this participant

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. The participant logged into her account twice on March 29, and Discovery Benefits received one
claim from the participant on that day. When entering claims online, a total amount will show at the bottom of the transaction summary screen prior to finalizing the submission. If a participant does not check the “Claims Terms and Conditions” box and does not click the “Submit” button before exiting, the documents will not complete the submission process. If the participant were to log off before submitting the page, the participant would see a message indicating that participant would lose the transactions if the participant logs off. If the participant closes their browser before submitting the claims instead of logging off, the participant will not receive a warning messageIf the participant has an email address in the system, once clicking on “Submit,” the participant will receive a claim confirmation email confirming that the claim was received and is being processed. Participants may also sign up for text alerts and can receive claim confirmation text alertsThe participant was notified of the receipt of one claim filed on March 29, As the other claims did not go through the complete submission process, there was no email notificationThe customer service representative assisting the participant did not state the system is faulty. Under certain circumstances, Discovery Benefits is able to generate a report for claims that are not fully submittedThe representative offered to run this report on behalf of the participant to determine if there were items left in her basket that could be pushed throughThere were no partially submitted claims for this participant

We will have a Participant Services representative reach out to the participant to help explain what information is still required from them in order to fully substantiate the expenses We do require that all information be provided in the same submission since we are unable to go back and review previous submissions for missing information

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. Hello Revdex.com team,Good day!I thank you so much for all your help and understandingI hope I understand your message correctlySo the remaining balance of $83.59, I can resubmit new receipts for this aside from son’s orthodontics? If so I have attached compiled receipts with label on themIf you need anything please let me knowAgain thanks for all your help.More Power and have a blessed day!Sincerely, *** ***

The letter to the participant was mailed July 18, Discovery Benefits notified the carriers of the coverage reinstatement as required under its agreement with the employer and also followed up with the carrier two additional times when we were advised the carrier had not updated their records Discovery Benefits is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers. In response to the original complaint, Discovery Benefits reached out again and received confirmation coverage from the two carriers that the participant’s coverage was reinstated effective December 1, All premiums received from the qualified beneficiary are remitted to the employer on a monthly basis for remittance to the carriersA refund for the June premium was mailed to the participant on July 1, A refund for coverage retroactive to December 1, cannot be provided

The participant is enrolled in an employer-sponsored “limited-purpose health flexible spending account” also known as a limited-purpose health FSAThe IRS limits the types of expenses eligible for reimbursement from the limited-purpose health FSA, allowing reimbursement only for eligible
dental, vision and preventive care expensesNo other medical services or non-preventive care expenses, including non-preventive care prescriptions, are eligible for reimbursement from this limited-purpose health FSATypically, limited purpose health FSAs are offered alongside a health savings account that can be used for other eligible medical expenses and non-preventive care prescriptions. Due to the limited expense eligibility, the debit card is only activated to work with vendors that use a Merchant Category Code (MCC) associated with dental and vision providersThe debit card will not work at medical providers such as hospitals, clinics and chiropractors nor will it work at pharmacies The participant may submit requests for reimbursement along with supporting documentation for eligible expenses not paid using the debit card either through the online consumer portal, via fax or by mail

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 employerDiscovery Benefits does not sell directly to individuals and does not have individual service agreements with
employees or participants
All claims submitted by this participant for the plan year have been settledThe participant used the carryover option to carry unspent funds from the plan year into Carryover funds are not available for reimbursement until after the full run-out period of the prior plan yearAs a result, the earliest the carryover funds were available to the participant was April 7,
As the participant did not elect to enroll in the medical flexible spending account for 2016, the funds did not automatically roll into The funds are now available and the participant’s debit card has been reactivated

I am rejecting this response because: I received a letter from Discovery Benefits detailing my issueIt stated there was an error on their part with entering my last day of work in their system, which led to them errantly approving my FSA reimbursement submissionsHowever, they did not offer any compensation for this egregious errorThis is unacceptable given the amount of money involved ($859.01)

Discovery Benefits is a third party administrator that provides 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
This participant was enrolled in and made contributions to a plan sponsored by her former employerThe plan in which she was enrolled was not a health savings account (HSA) as described in her complaintHSAs are governed by different rules than those that apply to flexible spending accounts offered through a cafeteria plan
Under the terms of the employer’s plan, terminated participants are allowed to submit eligible expenses incurred prior to the date of termination (final service date) up to days following the terminationThe participant has until March 2, (final filing date) to submit eligible expenses incurred while a participant in the plan

The plan in which this participant was enrolled was a plan sponsored by his employer for eligible employees. The employer defines how long a participant has to submit claims once that individual is no longer an eligible or active participant in the plan. Included in the letter we sent were excerpts from the summary plan description that was provided to each participant by the employer explaining the deadlines for submitting claims when participants lose eligibility to participate in the plan. In addition, these accounts are governed by IRS regulations which do not allow any refunds from the account if the funds are not used within the required deadlines. All funds that are forfeited are returned to the plan and are not retained by Discovery Benefits

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 employer under which this participant was continuing coverage through COBRA ended its group health plan effective December 31, According to its standard process for notifying participants of the termination of the group health plan, Discovery Benefits mailed a Plan Change Notice to this participant on January 11, The Notice provides information on the end dates of the plansA COBRA Termination Notice will be mailed to the participant this week

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meIf my reimbursement is not processed in June, as promised by Discovery Benefits, I will file another complaint

The plans in which this participant is enrolled are employer-sponsored plans governed by IRS regulations and plan rules as defined in the employer’s plan document and summary plan description Discovery Benefits provides administrative services on behalf of employers pursuant to service
contracts with the employer IRS rules governing substantiation requirements for the flexible spending accounts (FSA) require that all claims must be substantiated, even those paid using the debit cardSee 1.125-6(b)(2) and 1.125-6(3)(i) Discovery Benefits received documentation from the participant, however, some of the pages were cutoff or illegibleOther documentation provided showed a portion of the expenses were covered by insurance.Discovery Benefits is no longer the administrator for the employer’s plan and does not have the accounts set up within its systemThe participant will need to work with his employer if he has questions about his FSA for the plan year.The participant has until March 31, to file expenses for reimbursement that were incurred during the plan year Requests for reimbursement along with the complete documentation can be made through his Discovery Benefits online account or the Discovery Benefits mobile app The debit card can no longer be used for expenses.Even though debit card transactions may be denied due to lack of or insufficient documentation, the merchant remains paid Any funds that may remain in a participant’s account after the end of the plan year runout period are forfeited to the employer-sponsored plan and are not retained by Discovery Benefits

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 Claims for the employer’s Health Flexible Spending Account (FSA) are processed according to IRS regulations and the employer’s plan document and summary plan descriptionThe plan document provides specific timelines regarding terminated employeesAccording to the terms of the plan under which this participant was enrolled, his final service date was May 30, and his final filing date was August 29, As the final filing date for this participant has passed, the funds are forfeited to the employer’s plan and no longer eligible for reimbursement Information about the final service date and final filing date is included in the summary plan description provided by the employer to all participants upon enrollment into the planAdditionally, this information is readily available on the member portal Discovery Benefits has not received or denied any claims from this participant since June 26, We can see that the participant uploaded expenses into his expense tracker on the member portal, which is a tool to store and track expense information as a convenience for the participant. The expense tracker does not submit the claim for reimbursement