Discovery Benefits, Inc.

I am rejecting this response because:Discovery Benefits, Incresponse is misleading. As the plan administrator, the legal requirement to notify me of the early termination of the plan is solely the responsibility of Discovery Benefits, IncThe insurance carrier has no legal requirement under COBRA to do so. Discovery Benefits, Incaccepted my premium payment for the month of January. According to my bank records, it was deposited by Discovery Benefits, Incon January 9, 2018. I would like an explanation why they took over $1,of my money with nothing in return

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employerIRS rules govern substantiation requirements for the flexible spending account (FSA), including expenses paid using
the debit card This participant contacted Discovery Benefits by phone on August 7, The customer service representative taking the call answered the participant’s questions and offered to connect the participant with a supervisorThe participant declined and the conversation continued This participant contacted Discovery Benefits by phone on August 23, at 8:a.mThe customer service representative was not able to satisfy the participant and the participant requested to speak with a supervisorThere was no supervisor available and the participant was told a supervisor would call her back as soon as possible A Discovery Benefits supervisor called the participant and spoke with her at 8:a.mon August 23, The participant was advised the additional documentation she submitted on August 23, would be processed

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 does not issue insurance cards. Insurance cards are the responsibility of the carrier. Discovery Benefits' records show the coverage effective March 1, with a paid through date of March 31, 2016. The insurance carrier's records were incorrect, resulting in the new cards being mailed with the incorrect reinstatement date. On March 23, and again on April 7, 2016, Discovery Benefits contacted the carrier requesting that they update their records with the correct effective date of March 1, 2015. Confirmation was received from the carrier on April 7, that they had updated their records to show coverage effective March 1, The carrier should be providing new insurance cards now that their records have been updated to reflect the correct date

I am rejecting this response because: Discovery has not acknowledged my complaint or responded to itMy complaint is that Dicovery did not send my information to my insurance carrier in a timely manner after having received and processed my paymentsThey only sent my information after having my former employer contact them

I am rejecting this response because the business cannot dictate past IRS guidelines. Discovery Benefits makes up the rules as they go along in order for a consumer to lose their own money.  The money I entrusted with Discovery Benefits was never intended to be thrown away and I count on my hard earned to pay for expenses as listed in IRS Pub 502.  This organization is notorious for making up any reason to keep a participants money and it is deceitful on their company's part. I do not accept your response and firmly believe this company is a scam.  No other FSA treats participants in this way.  You cannot dictate what temporary storage means and their is nothing that states a woman must have surgery in the same year and use stored eggs in the same plan year.  The company is in the wrong and trying in way possible to bend the truth of what is written in IRS Pub 502.  I want my money reimbursed because I am within my legal right to have my own money reimbursed.  The date of the receipt was June 2017 and I turned in my paperwork on time.  The company denied my claim in May 2018.  I think Discovery Benefits is unethical and mishandles the money entrusted to their company if they have to make up excuses and not go by the IRS guidelines as the American public must do. This is unacceptable and I want my money reimbursed.

Discovery Benefits is a third party administrator that provides reimbursement account administrative services on behalf of employers pursuant to service contracts with the employer. The participant requested a replacement benefits debit card online.  When the card was received with his...

name on it, he cut up the card and requested a debit card in his wife’s name.  A new card was mailed to the participant in his wife’s name.Per the participant, the card has not been received, even though the address on file was verified as correct.The cards are sent in plain white envelopes and it may be the participant threw away the envelopes containing the debit cards sent previously thinking it was junk mail.We are attempting to contact the participant to try to assist him with his questions regarding the status of the debit card.

All premiums collected were remitted to the employer.  The employer has instructed DBI to have the participant contact the employer directly regarding their request.  DBI does not have the premiums being requested and cannot provide a refund.

I am rejecting this response because: This matter has been sorted out, but yet again Discovery Benefits fails to understand my complaint.  Five requests were made for a 2nd card in another person's (not my wife) name.  Nothing arrived, nor did I throw away a plain white envelope(s).

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.Discovery Benefits does not retain premiums collected. This participant’s April 2017 premium was remitted in May 2017 according to the process agreed upon between the employer and Discovery Benefits. Discovery Benefits has been in contact with the participant’s former employer and was advised the participant needs to contact the former employer regarding this matter.

I am rejecting this response because:
I don't feel that it should have taken 4 phone calls and contacting HR at my company to get in contact with someone at Discovery who could assist me and review my claim and clearly see that I submitted the proper documentation.  I submitted exactly what the representative told me to submit on the 16th, and yet whomever was reviewing the documents made an error resulting in more than 2 hours of my time having to contact Discovery Benefits over and over and over, and not until I complained to my employer did a supervisor from Discovery contact me.  The particular claim has been approved, but I will not fully accept the response from Discovery Benefits until my next claim is approved with submission of the "request for substantiation document," and no additional phone calls or hassle.   Additionally, I was told by the rep on the 14th during our phone conversation that I only need to have the "request for substantiation documentation" signed by my provider ONCE, and it would be sufficient for subsequent claims.  According to the supervisor who called me, this information was inaccurate and I will actually need to have the daycare provider sign every time I use by benefits card to pay for childcare, an inconvenience and also a bit discouraging that the representatives are not knowledgeable enough to provide an accurate answer or advice, even more unfortunate because supervisors are not easy to get in touch with.

This matter was resolved for the participant and he now has the cards requested.  If he has any other questions or concerns, we recommend he contact DBI's Participant Services.

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 card. See 1.125-6(b)(2) and 1.125-6(3)(i).  The participant has debit card transactions for which Discovery Benefits has received no documentation.  Two requests for documentation were sent for each debit card transaction.  When documentation was not received, the transaction was denied and a request for repayment sent.  Even though debit card transactions may be denied due to lack of or insufficient documentation, the merchant remains paid.  All of the email requests for documentation are visible through the participant’s online account under the Statements & Notifications tab. 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.  A request for reimbursement received on December 31, 2017 was processed and approved on January 2, 2018.  All funds have now been used by this participant and there are no remaining funds in the account to forfeit.  Substantiation for the debit card transactions remain outstanding.We place the utmost importance on customer service and strive to respond to calls as quickly as possible. We understand a participant’s frustration when not being able to get through and we do everything possible to limit the wait time for those trying to reach us.

Discovery Benefits provides administrative services on behalf of employers pursuant to service contracts with the employer. 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.  According to the terms of the Cafeteria Plan under which the participant is enrolled, participants are allowed to submit claims within 90 days after the end of the Plan Year. This information, copied below, was included in the Summary Plan Description provided to all eligible employees by the Plan Sponsor.  2. Claims Process ……….For the Dependent Care Flexible Spending Account, you must submit claims no later than 90 days after the end of the Plan Year....... The Final Service Date is the last date to incur claims (March 15, 2018) and the Final Filing Date is the last date to submit those claims in order to receive reimbursement (March 31, 2018).  This information was also available to the participant through the online consumer portal.  Notifications were sent to the email address on file for the participant.  Emails notifying the participant that their account statement is available are sent monthly.  Participants have the ability to change or update their notification preferences online at any time. 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.The participant contacted Discovery benefits by phone on November 20, 2017 and requested assistance logging into her account.  The Discovery Benefits customer service representative assisted her and stayed on the phone with her until she was able to access her account.  Discovery Benefits customer service hours are from 6:00 a.m. to 9:00 p.m. Central Time, Monday through Friday.

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.
The participant's employer maintained two plans with Discovery Benefits. The participant was enrolled in one plan for 2014 and the other plan for 2015.
Discovery Benefits received a manual claim from the participant on March 18, 2015. The claim included the name of the employer which matched the participant's plan for 2015 and the dates of service were all in 2015. As a result, the claim was processed from the participant's 2015 plan.
The claim was reimbursed on March 20, 2015 and the check cashed on April 1, 2015.
The participant contacted Discovery Benefits several times in 2015 regarding denied claims. Each time she called she requested to speak to a supervisor prior to allowing the customer service representative to determine the specific reason for her call. If there was a supervisor immediately available, her call was transferred. Several times there was no supervisor immediately available and a request for a call back within 24 hours was created.
Based on a review of Discovery Benefits call records, each time the participant requested to speak with a supervisor her call was transferred immediately or she was called back within 24 hours.
Discovery Benefits' Participant Services operates as an incoming call center to respond to inquiries from participants. The phone lines are kept open to the extent possible for incoming calls. When a supervisor is available at the time requested, the call is transferred. If no supervisor is available at that time, a callback request is processed and the participant will receive a call back from a supervisor within 24 hours. We understand this may frustrate some participants, but it is done so that participants who are waiting in the call queue to speak with a representative are not unreasonably delayed due to a participant needing to wait for a supervisor to be available.
The Discovery Benefits customer service team attempted to explain the documentation that was necessary for the March 18, 2015 claim to be re-processed from the 2014 plan year. The participant did not provide the documentation required and the 2014 plan year is now closed.

Discovery Benefits provides third party administrative services on behalf of employers. The account in which this individual participates is provided through her employer. Requests for documentation are required under IRS regulations.
The participant contacted Discovery Benefits by phone nine times between December 8, 2014 and March 9, 2016. Based on a review of Discovery Benefits call records, each time she called Discovery Benefits she requested to speak to a supervisor. If there was a supervisor immediately available, her call was transferred. Several times there was no supervisor immediately available and a request for a call back within 24 hours was created.
Multiple attempts were made on the part of Discovery Benefits customer service representatives and supervisors to assist the participant with the additional documentation necessary to substantiate her claims.
We are unable to provide any additional assistance on this matter as the 2014 plan year is closed in accordance with the employer’s plan requirements and the participant’s 2015 contributions have been exhausted.

Initial Business Response /* (1000, 5, 2016/01/14) */
Discovery Benefits is a third party administrator that provides COBRA administrative services on behalf of employers. Discovery Benefits does not sell directly to individuals. Discovery Benefits generally acts on instructions from employers,...

qualified beneficiaries, and/or insurance carriers. In its role as a third party benefits administrator Discovery 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 received and processed the participant's enrollment and initial payment amount on September 10, 2015. According to its standard process, on September 11, 2015 Discovery Benefits notified the carriers of the participant's reinstatement effective October 1, 2015.
Discovery Benefits was first made aware of the participant's lack of coverage on January 4, 2016 upon receipt of an email from the participant. Discovery Benefits reached out to the participant's medical carrier to ensure coverage on January 6, 2015.
Discovery Benefits received confirmation from the carriers for this participant on January 14, 2016 that all coverage elected has been reinstated effective October 1, 2015 with no lapse. Discovery Benefits also received confirmation that any claims denied since October 1, 2015 will be automatically reprocessed.
Initial Consumer Rebuttal /* (2000, 7, 2016/01/15) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I am finally insured. I cannot prove if the fault was with Discovery Benefits or Blue Shield. Maybe Blue Shield didn't register the notice properly. If I ever use COBRA in the future, I will verify my insurance on the date I am supposed to be insured instead of waiting until I need it.

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.

Initial Business Response /* (1000, 5, 2015/07/24) */
The participant used the benefits debit card to pay a claim with a date of service of May 21, 2015. Discovery Benefits notified the participant on June 15, 2015 of the requirement for further documentation as the documentation supplied indicated...

an estimated insurance benefit greater than the charges for the service. Discovery Benefits requested an explanation of benefits to determine the amount of the claim that could be approved. The participant contacted Discovery benefits on July 10, 2015 and was again advised that additional information was required.
The participant supplied an explanation of benefits that showed the full amount of the service was covered by insurance making the claim ineligible. IRS regulations do not allow for the reimbursement of a claim from an FSA if the same claim is paid or reimbursed by insurance or any other source. Even though the transaction has been denied, the provider of the service remains paid. The participant can either offset the ineligible transaction with another claim or pay back the ineligible amount. If paid back, the funds will be redeposited into the participant's FSA for use for another eligible claim.
At this time, the participant has two additional claims to the same provider where documentation has been requested. To date, no documentation has been received.
Initial Consumer Rebuttal /* (3000, 7, 2015/07/27) */
(The consumer indicated he/she DID NOT accept the response from the business.)
All three claims have been denied or are pending. Both I and the company (dentist office) have called and have been told to send EOB, which have already been submitted. They were faxed again with no resolution.
Final Business Response /* (4000, 9, 2015/07/28) */
Based on the documentation provided, the debit card transactions in question were for expenses that were paid by insurance. Per IRS regulations, reimbursement cannot be made for the same expense.

Discovery Benefits is a third party administrator that provides reimbursement account administrative services for employer-sponsored benefit plans pursuant to service contracts with the employer. The participant was enrolled in an employer-sponsored dependent care flexible spending account...

(FSA) for the January 1 – December 31, 2017 plan year.  These plans are governed by IRS regulations and the rules outlined in the employer’s plan document and summary plan description.According to the employer’s plan design for the dependent care FSA, terminated employees are allowed 90 days from the date of termination of employment to submit for reimbursement eligible expenses incurred prior to the termination date. This information is included in the Summary Plan Description provided by the employer to participants upon enrollment. The participant’s final service date was August 29, 2017 and the final filing date was November 28, 2017. This information was available on the participant web portal when the participant logged into her account on September 18, 2017 and November 21, 2017. Funds that are forfeited under IRS regulations are returned to the employer’s 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 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.
The participant elected continuation and authorized the initial premium payment on June 29, 2016 via the online member portal. On July 5, 2016, Discovery Benefits notified the carrier of the reinstatement of coverage for this participant effective July 1, 2016. Discovery Benefits has been advised by numerous carriers the standard enrollment time can take up to 15 business days.
Upon receipt of the first call from the participant on August 1, 2016, Discovery Benefits reached out to the carrier to confirm coverage. Discovery Benefits received confirmation on August 1, 2016 of the reinstatement of coverage effective July 1, 2016.
A Discovery Benefits customer service representative reached out to the participant with this information on August 1, 2016.