OCA Benefits Services

[redacted] submitted a claim for Dependent Care reimbursement in April of Her claim was processed within a day of receipt and denied due to the supporting documentation not meeting the requirements needed in order to release her paymentA letter stating that information and what action she needed to take in order to correct that was mailed directly to her homeAdditionally, she has access to our secure web portal in which she can see claims submitted, her account balances, and copies of any documentation sent to her homeHer claim was revisited earlier this week (June 2016) when she reached out to question her claim as she stated she never received the letter in the mail nor did she go online to reviewAs regulations change in this industry, we sent a copy of her documentation to legal counsel for reviewUpon their review it was determined that her claim could be paidThe dismissal was reversed and payment in full was madeShe was notified of this decision [redacted] mentions that "this is her money" and we are "just account holders"Although this "is" her money, the [redacted] requires administrators, such as us, to process these claims in accordance with the regulationsWhen the regulations are not met, payment cannot be issued

Complaint: ***
I am rejecting this response because: the various 'other' portals and links, if one can find them, don't work"Sorry, not available at this time" is the frequent result of spending yet another hour trying to resolve my issueMerely seeing that it is unresolved does me no good if I can't find a means to resolve the issueI note- today my wife (the employee) got an e-mail at work that representatives would be available at the hospital today to deal with unresolved issues...i.eI am not the only one by a long shot. I have NO problem with the requirement for documentation as per the ***I have significant problem with a company that makes documentation so difficult. I did get a representative to call me late Fri afternoon - said my previous documentations went through just fine - for some odd reason, the three times I sent the last documentation, did notShe had no answers
Regards,
*** ***

The complaint revolves around the use of a "debit card" that is associated with Health Reimbursement Arrangements and Flexible Spending AccountsThese cards are issued for the purpose of giving an individual access to funds either earned from their employer or funds they have contributed through
payroll deductionsIn either case, these types of plans are governed by *** regulations which mandates how the funds may be usedThat said, when an individual uses the card the *** requires that specific documentation is provided to support each charge ensuring the card is used in accordance with the regulationsThis also mandates that if said documentation is not provided within a reasonable amount of time, that the card is to be shut off from use until resolvedKeep in mind, when using the card we are able to see where the swipe took place, the amount charged and the date it was swipedHowever, without the supporting documentation being submitted, we are unable to ascertain if the charge was for services within the plan year, for a covered dependent under the plan, or for services that are deemed "eligible" under *** code ***)That all said, there are several system-generated emails to our clients that provide status updates regarding each of their swipes and what action, if any, is needed on their partThis is in an effort to eliminate the need of someone needing to call or wait on hold for a representativeAdditionally, all of our clients have access to a secure web portal that gives them the ability to see their account, submitted claims, debit card activity, etcIndividuals also have the ability to submit their claims a variety of methods - can be online through the web portal, via email, sent regular mail, our mobile app with the ability to snap a picture if they don't have the ability to scan a documentWe provide customized materials to every client and their employees that details this information, access to the portal, as well as examples of the documentation that is neededChris unfortunately did not submit what was required to prevent the card from being shut downOnce OCA receives that required paperwork, the card is turned back on for future useAgain, this is due to *** rules

[redacted] submitted a claim for Dependent Care reimbursement in April of 2016. Her claim was processed within a day of receipt and denied due to the supporting documentation not meeting the requirements needed in order to release her payment. A letter stating that information and what action she...

needed to take in order to correct that was mailed directly to her home. Additionally, she has access to our secure web portal in which she can see claims submitted, her account balances, and copies of any documentation sent to her home. Her claim was revisited earlier this week (June 2016) when she reached out to question her claim as she stated she never received the letter in the mail nor did she go online to review. As regulations change in this industry, we sent a copy of her documentation to legal counsel for review. Upon their review it was determined that her claim could be paid. The dismissal was reversed and payment in full was made. She was notified of this decision. [redacted] mentions that "this is her money" and we are "just account holders". Although this "is" her money, the [redacted] requires administrators, such as us, to process these claims in accordance with the regulations. When the regulations are not met, payment cannot be issued.

Apologies for the delay in a response to the inquiry, however, the owner of O.C.A. (Steve Honig) and myself had spoken to someone on the phone a while back at Revdex.com that took our response over the phone and we were told nothing further would be needed. That said, I am now being told that a...

written response is required, so if you would kindly add our response to this compliant it would be appreciated. The complaint was issued by [redacted] Hasili, a former employee of the YWCA Princeton.  Her account and all notifications are in compliance as stipulated by Federal COBRA.  Below is the chain of events regarding her account. ·         Employment ended 05/30/14·         O.C.A. was notified of her termination on 06/02/14·         O.C.A. sent out her COBRA election letter on 06/05/14·         [redacted] elected COBRA for medical, dental and vision coverage on 07/01/14·         O.C.A. sent out payment vouchers for her medical, dental and vision elections on 07/07/14 ·         O.C.A. sent out a revised election letter to include HRA and FSA election options on 07/10/14·         O.C.A. sent out a “failure to accept” notice regarding the HRA and FSA on 09/15/14 YWCA Princeton has a rate change on 04/01/14.  O.C.A. was notified on 09/16/14 that the rates were inaccurate.  As a result:·         O.C.A. sent out revised coupons on 09/18/14 Subsequently [redacted] was charged $762.16 for July, August and September.  New rate was $707.84 per month – a difference of $54.32.  A total of $162.96 was applied toward her October premium.  YWCA Princeton experienced another rate change for their dental and vision plans on 03/01/15.·         O.C.A. sent out revised coupons to [redacted] on 03/13/15 notifying her of this change YWCA Princeton then experienced another rate change for their medical plan on 04/01/15.  We were notified of this change prior to 04/01/15.·         O.C.A. sent out another revised set of coupons to [redacted] on 03/17/15 to include this additional rate change. It is important to point out that payment vouchers/coupons are NOT a legal requirement.  O.C.A. sends them as a courtesy to the participant.  Again, all notifications were sent timely and in accordance with Federal guidelines relating to the administration of COBRA. Please let me know if you have any questions or need additional information.  [redacted]                           ...⇄ President, Quality & Product Management O.C.A. Benefit Services-  [redacted]  *  [redacted]  *  [redacted]
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