Discovery Benefits, Inc.

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 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, 2016/01/25) */
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 received and processed the participant's January 2016 premium payment on January 8, 2016. According to Discovery Benefits' standard process, there is a mandatory 14-day waiting period to ensure collected funds.
Discovery Benefits is currently working with its client, the participant's former employer, to determine the next steps with regard to the reinstatement of active coverage in order to ensure continuous coverage. Any applicable refund will be processed upon confirmation from the client.

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.  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, 8, 2015/06/03) */
The participant submitted a claim on March 15, 2015. A portion of the claim was approved and a reimbursement check mailed to the address on file with Discovery Benefits on March 18, 2015.
The participant contacted Discovery Benefits on April...

6, 2015 and indicated that he had not received the check mailed on March 18, 2015. The original check was voided and a check re-issued and mailed to the address on file with Discovery Benefits on April 6, 2015.
The participant contacted Discovery Benefits on April 29, 2015 and indicated that he had not yet received the re-issued check. The Discovery Benefits customer service representative confirmed the mailing address, walked the participant through the steps to set up direct deposit for his reimbursement and advised that once the direct deposit was set up the replacement check would be voided and re-issued as a direct deposit. The Discovery Benefits customer service representative did not advise the participant that he would need to call in to confirm that he had completed the direct deposit set-up.
The participant contacted Discovery Benefits on May 14, 2015 and advised that he had not yet received the expected payment. The Discovery Benefits customer service representative advised that the participant needed to call Discovery Benefits and advise that the direct deposit process had been completed. Another replacement check was issued and mailed to the participant on May 14, 2015. Due to the plan closing on May 13, 2015 the only option for reimbursement was by check.
A Discovery Benefits customer service representative contacted the participant by phone on May 22, 2015 and advised that reimbursement could not be done through direct deposit and a check was mailed on May 14, 2015.
The participant contacted Discovery Benefits on May 28, 2015 and indicated that the check was received but was destroyed due to the understanding that the reimbursement would be a direct deposit. Another check was issued on May 28, 2015 and mailed to the participant at the address on file.

I am rejecting this response because: I have talked with the carrier and they have still not received information crom 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 is not an insurance carrier and does not have access to or control of the records or processes of insurance...

carriers. Discovery Benefits processed annual plan and rate changes on behalf of the former employer of this participant on January 5, 2018 and according to its standard process for updating eligibility, notified the carriers of updates to coverage on January 6, 2018 and January 8, 2018. Discovery Benefits reached out to the new medical carrier on behalf of this participant with an urgent update request on January 9, 2018. Discovery Benefits was advised by the carrier that members from this group were currently being added to their system and there was not a way to reinstate coverage until the member was added. Discovery Benefits receive verbal confirmation of updated coverage from the medical carrier on January 10, 2018. Discovery Benefits was informed it may take 24 hours for providers to see the coverage as active. A Discovery Benefits representative will reach out to the participant by phone with this information today. During this time of year when a large number of employers and their employees are going through open enrollment, our call volumes and wait times may increase at any given time during the day. We place the utmost importance on customer services and strive to respond to calls from participants as quickly as possible and keep the wait times as short as possible. Discovery Benefits also provides an email and chat option for participants through discoverybenefits.com.

Due to the amount of information required to provide a detailed response, Discovery Benefits is sending a letter directly to the participant in response to this complaint.

The participant enrolled in his employer’s Dependent Care FSA in 2016 while active with his employer. These plans are governed by IRS regulations and the employer’s plan design.
The participant terminated his employment in May 2016. Per this employer’s plan design, terminated participants are...

not able to incur any additional expenses after their last date as an active employee and have 90 days from their last active date to file for reimbursement for expenses incurred while an active employee.
Paragraph 5 under Section V Benefit Payments in the Plan’s Summary Plan Description (SPD) includes this language:
5. What happens if I terminate employment?
If you terminate employment during the Plan Year, your right to benefits will be determined in the following manner:
(a) You will remain covered by insurance, but only for the period for which premiums have been paid prior to your termination of employment.
(b) You will still be able to request reimbursement for qualifying dependent care expenses incurred prior to your date of termination from the balance remaining in your dependent care account at the time of termination of employment. However, no further salary redirection and Employer contributions will be made on your behalf after you terminate. You must submit claims within 90 days after termination.
(c) For health benefit coverage and Health Flexible Spending Account coverage on termination of employment, please see the Article entitled "Continuation Coverage Rights Under COBRA." Upon your termination of employment, your participation in the Health Flexible Spending Account will cease, and no further salary redirection and Employer contributions will be contributed on your behalf. However, you will be able to submit claims for health care expenses that were incurred before the end of the period for which payments to the Health Flexible Spending Account have already been made. Your further participation will be governed by "Continuation Coverage Rights Under COBRA."
The participant had until August 4, 2016 to file eligible expenses. This information would have been communicated to the participant by the employer through the SPD, at enrollment and/or at termination. In addition, the final service and filing dates are available through the participant’s online account.
The participant filed one claim in April 2016, leaving a remaining balance of $416.66. Because no additional claims were filed prior to the final filing date, these funds have been forfeited back to the employer’s plan and are no longer available to the participant. Discovery Benefits does not retain any of the forfeited funds.

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 reached out to the employer regarding their runout period for terminated employees and was...

informed that it was the employer’s intent to allow terminated employees a runout period of 90 days following the end of the plan year. As a result, this participant is allowed to file expenses for services incurred prior to his termination date until March 31, 2018. The participant may file for reimbursement through online through the portal, via the mobile app or by completing an out-of-pocket reimbursement request form. We will reach out to the participant by phone to let him know of the extension to file claims.

The carryover feature is an option the employer sponsoring the health flexible spending account must adopt and is voluntary on the part of the employer. The health flexible spending account under which this participant was covered for the 2015 Plan Year did not allow for the carryover of...

unused funds to the next Plan Year. As a result, any balance remaining as of the final filing date for the Plan Year was forfeited.
This information was provided to all Plan participants in Section V.2. of the Summary Plan Description provided by the employer:
2. What happens if I don't spend all Plan contributions during the Plan Year?
Any monies left at the end of the Plan Year will be forfeited, except for amounts contributed to your Health Savings Account. Obviously, qualifying expenses that you incur late in the Plan Year for which you seek reimbursement after the end of such Plan Year will be paid first before any amount is forfeited. For the Health Flexible Spending Account, you must submit claims no later than 90 days after the end of the Plan Year. For the Dependent Care Flexible Spending Account, you must submit claims no later than 90 days after the end of the Plan Year. Because it is possible that you might forfeit amounts in the Plan if you do not fully use the contributions that have been made, it is important that you decide how much to place in each account carefully and conservatively. Remember, you must decide which benefits you want to contribute to and how much to place in each account before the Plan Year begins. You want to be as certain as you can that the amount you decide to place in each account will be used up entirely.

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 final service date and final filing dates are defined by the terms of the Plan under which the participant was enrolled. This information is included in the Summary Plan Description provided by the employer to each participant becoming enrolled in the Plan.  A letter will be sent to the participant that includes additional information.

I am rejecting this response because:The actions taken and services provided by Discovery Benefits were not sufficient. The monthly account notifications sent are nothing more than an invitation to log into your account, and contain no personalized or meaningful information. The deadlines may have been included in the plan documents, but those were last seen when my family originally signed up for the plan over three years ago. At no point did Discovery Benefits ever specifically send notification of the upcoming 3/31 deadline, and its consequences. Additionally, I had been trying to submit a claim since mid-January for the balance of my 2017 account. After three incorrect password attempts that account locked me out of the system. The only way to log back in was so call Discovery Benefits. Their call center is open only on weekdays. I have three kids and my wife and I both work. Weekdays are not particularly convenient. I tried to call a handful of times and was met with long hold times each time. I finally was able to call and get through to reset my password on 4/6, nearly three months later.Had Discovery Benefits taken any of the following actions or provided any of the following services, this situation could be avoided:-provided adequate call center staff during working hours to limit hold times-provide call center hours on the weekend-change their password reset capabilities so that it does not require calling the call center-send a personalized email and/or letter notification of impending claims deadlines and forfeiture consequences for all accounts with a remaining balance [redacted]

I am rejecting this response because: Discovery Benefits tells me I should have seen that disclaimer, yet it is not accessible anywhere in my account or on their website. They can't link to it or show where that appears in their terms of use. Additionally, even according to the message they referenced, it says "This MAY require you to mail a payment" (emphasis mine). When looking at my account, it appears totally active, with scheduled payments active. A rational person would certainly rely on that representation and conclude that since I signed up for scheduled payments within days of receiving their takeover notice, I am not one of those that is requiretd to mail an additional payment.

I am rejecting this response because:
This company is the "Administrators" for our company's HSA. Although the plan date had passed when the provider swiped my card once for 2 different transactions, one of the services were within the previous plan period. when I discovered the payment error, I sent verification that the covered charged were for the previous plan year. They advised me after the fact that I had until 4/30 to submit for a reimbursement, which would have resolved my issue. If they would have done there job and responded appropriately to my email inquiry I could have submitted the proper paperwork with their guidance. I was told they did not tell me what to do to get reimbursed because my email did not have a "specific question". It's very clear in my email that I'm trying to resolve the payment issue. I want Discovery to reimburse me for my money because they did not do their do diligence as "Administrators". I do not know the rules or how they operate. I understand the government has their own rules and can not be broken or bent. I want Discovery as Administrators to refund me my $124.30 because the government will not.

A letter is already in today's mail to the individual.  Privacy concerns do not allow us to provide the level of detail needed through the Revdex.com.

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(3)(i) In general. 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. Self-substantiation or self-certification of an expense by an employee does not satisfy the substantiation requirements of this paragraph. Even though the debit card transactions may be denied if proper substantiation is not received, the merchant remains paid.  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.

Discovery Benefits has completed a second review of the participant’s account and can find no record of the claim being filed or documentation being uploaded to the online consumer portal Dashboard or Expense Tracker.   We are unable to take any further action on this matter unless we are provided proof of the attempt to file an online claim prior to the final filing date.

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 received confirmation of the reinstatement of coverage for the participant on September 13, 2016.
We place the utmost importance on customer service and understand that the participant’s experience has been frustrating and we apologize for her frustration. The situation causing the delay in processing the continuation coverage for this participant has been addressed.
Discovery Benefits will send a letter to the participant that provides additional detail on this matter.

Discovery Benefits sent a very detailed letter explaining why the documentation submitted could not be accepted for each of the transactions that could not be approved.
Health care reform allows health FSAs to reimburse expenses for medicines or drugs only if the medicine or drug (1) requires a prescription, (2) is available without a prescription (i.e., an OTC drug) and the individual obtains a prescription, or (3) is insulin. To show that an OTC drug has been prescribed, employees must also submit the prescription, a copy of the prescription, or other documentation that a prescription has been issued, along with the other independent third-party substantiation required under IRS rules. IRS Notice 2010-59, 2010-39 I.R.B. 396.
Not a Qualifying Expense. These are expenses in one of the following categories: Expenses that are generally known to be incurred or obtained primarily for personal, cosmetic, or general health purposes and not primarily for medical care. These “primarily personal” expenses almost never qualify for reimbursement from a health FSA or HRA or for a tax-free distribution from an HSA. Expenses in this category theoretically could qualify in the extremely rare case where an individual can overcome a strong presumption of non-qualification and prove that, based on all the facts and circumstances and taking into account the prevailing IRS guidance, the item or service was incurred or obtained primarily to treat an existing medical condition diagnosed by a medical practitioner.

I am rejecting this response because: per Mayo Health Solutions Discovery Benefits has not sent over my information. They neglected to start the process for me when Mayo sent the initial forms over. This is not an acceptable way to do business or treat people. If I treated patients like this - people would die. They have not sent the info to Mayo Health Solutions.