Tri-Ad

Participant has elected to participant in her company’s Flexible Spending Account for both plan years 2015 and 2016. Flexible Spending Accounts are pre-tax accounts that are governed by Section 125 of the IRS Code, as well as the required Plan Document that outlines all of the rules for the plan....

The IRS requires that all expenses paid from the Flexible Spending Account are adjudicated to ensure that the expense is an eligible expense under the IRS regulations.In order to facilitate the use of the account, TRI-AD provides a debit card for participants to access the funds. However, with the use of the debit card, TRI-AD is still required to verify that the expenses paid using the debit card are eligible. If a participant does not respond timely to the request for documentation, certain IRS guidelines must be followed, (1) deny access to the debit card (shut it off for future transactions), until the transaction in question is resolved, (2) Require repayment of the claim, which is then added back to the annual amount to be used for an eligible expense during the plan year, (3) offset the claim with another eligible claim, (4) withhold from pay – if repayment is unsuccessful, then an amount equal to the ineligible claim can be withheld from the participant’s pay or other compensation.All debit card transactions are adjudicated based on IRS regulations. The IRS regulations allow transactions to be auto adjudicated in the following situations, (1) if the transaction matches a copayment amount for the employer’s benefit plans, (2) the transaction matches an IIAS (Inventory Information Approval System) used at Pharmacies, (3) the transaction is a recurring transaction at the same provider for the same dollar amount of a transaction that has already been adjudicated.In the case of Tabitha Twitchell, she had an election of $1,500 for the 2015 plan year and an election of $250 for the 2016 plan year. The 2015 plan year’s expenses must be incurred between January 1, 2015 and December 31, 2015 and participants have until April 15, 2016 to submit any claims. The 2016 plan year’s expenses must be incurred between January 1, 2016 and December 31, 2016 and participants have until April 15, 2017 to submit expenses.Tabitha Twitchell used her BenefitCard starting March 2, 2015 and continued to use it through July 2015. She used the card for a total of $1,500.00. Then on August 7, 2015 we received a credit from a merchant of $70.00. Many of her transactions we were able to auto adjudicate based on the rules stated above, however there were 4 transactions that we needed documentation from the participant showing, (1) date of service, (2) description of service, (3) amount of service, (4) who the service was provided for, (5) the provider’s name. In reviewing the account 3 of the 4 transactions documentation has been provided, based on information given during a call on January 6, 2016 with TRI-AD’s participant services. However there is still one outstanding claim that we need documentation on before we canPage 1 of 2 January 14,2016turn on the debit card for the 2016 plan year from April 24, in the amount of $896.01. This was paid to the provider, but we have not received documentation for this claim as of today.In order for us to active her BenefitCard, she will need to provide documentation for the claim mentioned above, as this is still an outstanding issue on her account. Once the documentation has been provided, we can determine if the expense is an eligible expense. If it is an eligible expense, the card will be turn on and can be used for the 2016 plan year. If the expense is determined to be an ineligible expense, the participant can submit claims for other expenses that she did not use the BenefitCard for, that we can use to offset this expense. Once that is completed, the card will be turned on for the 2016 plan year.The balance remaining in her 2015 plan of $70.00, she has until April 15, 2016 to submit a claim for reimbursement for eligible expenses that were incurred during the 2015 plan year.She has a balance of $250.00 for the 2016 plan year that she can use once the 2015 outstanding transaction is resolved. This amount can be use for any eligible expenses that are incurred during the 2016 plan year, and she has until April 15, 2017 to submit any request for reimbursements.At this point, we are in need of action taken by the participant to resolve the one outstanding 2015 claim from April 24, 2015 for $896.01. After this transaction is resolved her account will be available for use, and she will be able to access both her remaining $70 from the 2015 plan as well as her entire balance of $250 from the 2016 plan year.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
I have requested the phone records and written records from Tri Ad and have been refused.  What they state is different than what I experienced.  Can you please ask Tri Ad to provide a copy of the written and phone records for me to review?  I asked in that past and was refused.  They claim this, but I remember the conversations and the information was different.  The only way to view this and have proof, is to review the phone and written records they say they have and which they summarize in the message they provided.  Can you please ask them to provide the written and phone recordings they have so I can review them as well?
Regards,
[redacted]

Please see attached. [redacted]Daytime phone: ([redacted])-[redacted]Email: [redacted]Revdex.com ID [redacted]It TRI-AD’s policy to not release any recorded phone conversations, we can however provide a summaryof the calls. In reviewing the account information for the original response, there were no requests forany records, emails or phone calls.I am providing a copy of the email correspondences between TRI-AD and the participant, as we only takewritten instructions for COBRA coverage. In addition, I have provided the dates and summary of thecalls below.In the case of this participant, the following phone discussions and email exchanges took place duringNovember 2013 – April 2014.· November 19, 2013 participant called and inquired about the amount that was due forDecember premium. She also inquired if she would be able to keep just vision and dentalcoverage. She was informed that we would need something in writing stating that she wants todrop the medical coverage and keep the vision and dental.· December 4, 2013 participant called and explained that she was trying to get Obama Care anddoes not yet want to drop her medical coverage. She was informed that she should send anemail stating that she does not want to drop her medical coverage.

Review: In January of 2015 I received a $1500 FSA [redacted] card from TRI-AD. I was able to use the [redacted] without issue until November of 2015. I recieved a government mandated letter through TRI-AD stating that I had $270.00 left in my FSA to utilize before the end of the year. I called the number on the back of the card to check the automated response system which stated that I still had $270.00 left on my card. I then tried to use the card for perscription Co-Pays at my pharmacy but the card was declined due to insufficient funds. I assumed TRI-AD had made an error and that I had exhausted my funds for 2015. Flashforward to this week, January 2016. New year and new open enrollment. This year I had elected to only put $250.00 in TRI-AD's FSA since my daughter had completed all her orthodontic work. I attempted to use the card to order contact lenses for myself but the card was declined. Once again I called the automated service which stated that I had $250.00 for the year to spend. Confused, I decided to speak with a customer service rep "[redacted]". She informed me that they had kept the $270.00 from 2015 and that they had also froze my 2016 elections until I submit receipts for two purchases I had made back in June and July of 2015. I asked her I how I was supposed to know to submit receipts for those two purchases?(I made dozens of purchases) She said that they had sent an email to me. When I asked her to verify the email adress, apparently someone mis-entered my email and spelled the word "Verizon" incorrectly as "Verizen". When I asked if she could correct the mistaken email, refund the $270, and unfreeze the benefits for 2016, she said "no". She told me that the two receipts, one for 165.45 (ortho retainers) and the other for 82.36 (contacts) would have to be sent to them in order for them to take my money off "hold" for 2016. They have already kept $270.00 of my money from 2015 for those 2 receipts totaling less than that amount and are also keeping 2016's $250.00.Desired Settlement: Something just doesn't seem legal about this. especially since I had no knowledge of an incorrect email entry and they had never attempted to contact me via regular US postal mail, which they could do successfully since they mailed me the government mandated letter with no problem. I request that my email be updated and spelled correctly. I also request a refunded amount of $270.00 from my 2015 elections and I request that my 2016 benefits be taken off hold immediately. The two requested receipts were sent via fax yesterday. Thank you.

Business

Response:

Participant has elected to participant in her company’s Flexible Spending Account for both plan years 2015 and 2016. Flexible Spending Accounts are pre-tax accounts that are governed by Section 125 of the IRS Code, as well as the required Plan Document that outlines all of the rules for the plan. The IRS requires that all expenses paid from the Flexible Spending Account are adjudicated to ensure that the expense is an eligible expense under the IRS regulations.In order to facilitate the use of the account, TRI-AD provides a debit card for participants to access the funds. However, with the use of the debit card, TRI-AD is still required to verify that the expenses paid using the debit card are eligible. If a participant does not respond timely to the request for documentation, certain IRS guidelines must be followed, (1) deny access to the debit card (shut it off for future transactions), until the transaction in question is resolved, (2) Require repayment of the claim, which is then added back to the annual amount to be used for an eligible expense during the plan year, (3) offset the claim with another eligible claim, (4) withhold from pay – if repayment is unsuccessful, then an amount equal to the ineligible claim can be withheld from the participant’s pay or other compensation.All debit card transactions are adjudicated based on IRS regulations. The IRS regulations allow transactions to be auto adjudicated in the following situations, (1) if the transaction matches a copayment amount for the employer’s benefit plans, (2) the transaction matches an IIAS (Inventory Information Approval System) used at Pharmacies, (3) the transaction is a recurring transaction at the same provider for the same dollar amount of a transaction that has already been adjudicated.In the case of Tabitha Twitchell, she had an election of $1,500 for the 2015 plan year and an election of $250 for the 2016 plan year. The 2015 plan year’s expenses must be incurred between January 1, 2015 and December 31, 2015 and participants have until April 15, 2016 to submit any claims. The 2016 plan year’s expenses must be incurred between January 1, 2016 and December 31, 2016 and participants have until April 15, 2017 to submit expenses.Tabitha Twitchell used her BenefitCard starting March 2, 2015 and continued to use it through July 2015. She used the card for a total of $1,500.00. Then on August 7, 2015 we received a credit from a merchant of $70.00. Many of her transactions we were able to auto adjudicate based on the rules stated above, however there were 4 transactions that we needed documentation from the participant showing, (1) date of service, (2) description of service, (3) amount of service, (4) who the service was provided for, (5) the provider’s name. In reviewing the account 3 of the 4 transactions documentation has been provided, based on information given during a call on January 6, 2016 with TRI-AD’s participant services. However there is still one outstanding claim that we need documentation on before we canPage 1 of 2 January 14,2016 turn on the debit card for the 2016 plan year from April 24, in the amount of $896.01. This was paid to the provider, but we have not received documentation for this claim as of today.In order for us to active her BenefitCard, she will need to provide documentation for the claim mentioned above, as this is still an outstanding issue on her account. Once the documentation has been provided, we can determine if the expense is an eligible expense. If it is an eligible expense, the card will be turn on and can be used for the 2016 plan year. If the expense is determined to be an ineligible expense, the participant can submit claims for other expenses that she did not use the BenefitCard for, that we can use to offset this expense. Once that is completed, the card will be turned on for the 2016 plan year.The balance remaining in her 2015 plan of $70.00, she has until April 15, 2016 to submit a claim for reimbursement for eligible expenses that were incurred during the 2015 plan year.She has a balance of $250.00 for the 2016 plan year that she can use once the 2015 outstanding transaction is resolved. This amount can be use for any eligible expenses that are incurred during the 2016 plan year, and she has until April 15, 2017 to submit any request for reimbursements.At this point, we are in need of action taken by the participant to resolve the one outstanding 2015 claim from April 24, 2015 for $896.01. After this transaction is resolved her account will be available for use, and she will be able to access both her remaining $70 from the 2015 plan as well as her entire balance of $250 from the 2016 plan year.

Review: I cancelled my health insurance in fall of 2013. In Spring of 2014, I found out that a mistake with my bank, several payments for the insurance had gone out to Tri Ad for the medical insurance payments. I called Tri Ad, and explained that the online banking program had made a mistake, and reminded them that I had cancelled my health insurance, and requested a refund for the money they had kept. They refused. They claimed that my cancellation was "confusing" and they said that they had applied my payments already, and they refused to send back the payments. This gutted my savings. They had sent me back one month's payment, but gutted almost $3000 from my savings account, causing me tremendous financial hardship. I did not use the insurance, thinking I did not have it. I was nearing the end of my cobra period, and had qualified for the state medicaid. I did not need it any longer and couldn't afford it. The agent I talked to in November of 2014 when I called to cancel my insurance, created anxiety in my mind, she was encouraging me not to cancel it for fear of what would happen to obama care. I told her to cancel the insurance, I would talk to my parents, and if some way came up that I could extend it I would call back, but as of then I couldn't afford to keep the medical insurance, and I was canceling my health insurance, and was extending my dental and vision for two months. I asked her if she needed anything more from me. She said no. When my bank made the mistake of sending the payments out, Tri Ad cashed them despite my canceling the policy. When I asked them to refund the payments, they refused and said that because I didn't submit a cancellation in writing, that they were not going to refund the money. However, when I cancelled the medical insurance, I asked the agent if I needed to send anything in a letter or in email. She said no. Now they say it's my fault. I would like my money refunded to me.Desired Settlement: I would like the money that was sent to Tri-Ad on my behalf after canceling my policy to be refunded to me.

Business

Response:

Please see attchment for response. [redacted] E [redacted] Street[redacted], AZ [redacted]Daytime phone: ###-###-####Email: [redacted][email protected] coverage can be terminated early if the participant provides written instructions to terminatetheir coverage, or the fail to make payment for the coverage. COBRA coverage cannot be cancelled viaphone conversation, as we require COBRA coverage termination requests to be in writing. Any coveragewriting COBRA coverage termination requests must be made before the end of the coverage period. Forexample, if a participant wants to have coverage terminated for January, the request must be made inwriting before the end of January. If payment is made for the January coverage month, and the requestto cancel the coverage is made in February, we would only be able to terminate the coverage at the endof January, so the participant would be covered for the month of January.In the case of this participant, the following phone discussions and email exchanges took place duringNovember 2013 – March 2014.· November 19, 2013 participant called and inquired about the amount that was due forDecember premium. She also inquired if she would be able to keep just vision and dentalcoverage. She was informed that we would need something in writing stating that she wants todrop the medical coverage and keep the vision and dental.· December 4, 2013 participant called and explained that she was trying to get Obama Care anddoes not yet want to drop her medical coverage. She was informed that she should send anemail stating that she does not want to drop her medical coverage.o Email from participant: I have been applying for ACCHS and Obama care, at themoment, I fall in between both programs so there have been delays ininformation, and some misinformation with my insurance decisions. My parentsare trying to figure out if they can help me with my December payment for thecobra. I've already paid the amount for my dental and my vision. I've been waitingfor my paperwork to have answers so I apologize for the delay. Before youcancel the medical insurance, please keep my vision and dental active, whichI've already paid $45 for, and please wait on canceling my medical insurance,as I am trying to ask my parents to pay for the December payment of $238.25. I need a couple days to reach them and for them to make a decision and ifthey say yes, a payment will be made immediately with a check in the mail, if notI will send a further email.· December 4, 2013 – participant called and confirmed receipt of email requesting us to notcancel her medical coverage.· December 23, 2013 – payment for her December coverage and part of her January coveragewas received. As such coverage for December was not terminated, we had received payment(within the grace period) and the participant had not provided written instructions to terminateher coverage.· January 16, 2014 – payment for the rest of the January coverage and part of her Februarycoverage was received.· January 21, 2014 – participant called to confirm payment was made for January. Stated that shehad cancelled the payment with the bank, but they made the payment anyway. She would needto contact the bank on the issue, as we do not control when a bank makes a payment. Shestated that she would call back to deal with the coverage issue.· February 13, 2014 – payment for February coverage and part of her March coverage wasreceived.· February 18, 2014 – participant called upset that her medical coverage was not terminated.Explained that we received written instructions from her in December to not terminate thecoverage, and we had received payment for the coverage.· February 20, 2014 – Received email requesting coverage termination for Medical back toFebruary 1, 2014 and a refund of any payments made for February or later.o Can you please term the medical coverage back to February 1st, 2014 ($617.40)and the unapplied amount of ($263.12).I had very much hoped you could find a way to refund the other two paymentsof 611.47 and 608.47 which were issued 12/23 and 1/17, since I had setup billpay with my bank to cancel all payments that included the medical, dental, andvision, and only paying for the dental and vision.If you can find it in your heart, and in your ability to find a way to do this, I wouldgreatly appreciate it. My intention was for my medical insurance to be cancelledstarting December 2014 and onward, only keeping my dental and vision activeuntil February 1st.Please do go ahead and term what you have decided that you can, which Iappreciate, and if it is possible to term the rest, I will be happy to complete anappeal for this for the other two payments, and the removal from the total ofthe 2nd payment of 45.19 which covered just the dental and vision if approved.My family is helping me now with my finances since this mistake, because I havebeen going through tremendous health issues. This is why I ask that in kind, ifany exceptions can be made in this case, it would be greatly appreciated.· February 24, 2014 – Received email requesting coverage termination for Dental and Vision backto January 31, 2014.o The dental and vision is to end 1/31. Please refund that amount as well.[redacted]· March 19, 2014 – Refund check #990 for $925.14 was mailed to participant. This amountreflected the amount she had paid for February coverage and part of March coverage. Theamount that was returned to her included funds from her check #9177 for $608.47, and part ofthe funds from check # 3140 $316.67. This represented the funds paid for coverage in February,which was $662.02 ($36.96 for Dental, $617.40 for Medical, $7.66 for Vision), the remaining$263.12 would have been applied to her March coverage.The only written instructions that we received to terminated coverage was on February 20, 2014 forMedical coverage and on February 24, 2014 for Dental and Vision coverage. Based on the writtenrequest we terminated the coverage back to January 31, 2014 and we refunded any payments forFebruary and March, in the amount of $925.14. The participant had medical, dental and vision coveragethrough the end of January 2014 and is not due any additional refunds at this time.

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

I have requested the phone records and written records from Tri Ad and have been refused. What they state is different than what I experienced. Can you please ask Tri Ad to provide a copy of the written and phone records for me to review? I asked in that past and was refused. They claim this, but I remember the conversations and the information was different. The only way to view this and have proof, is to review the phone and written records they say they have and which they summarize in the message they provided. Can you please ask them to provide the written and phone recordings they have so I can review them as well?

Regards,

Business

Response:

Please see attached. [redacted]Daytime phone: ([redacted])-[redacted]Email: [redacted]Revdex.com ID [redacted]It TRI-AD’s policy to not release any recorded phone conversations, we can however provide a summaryof the calls. In reviewing the account information for the original response, there were no requests forany records, emails or phone calls.I am providing a copy of the email correspondences between TRI-AD and the participant, as we only takewritten instructions for COBRA coverage. In addition, I have provided the dates and summary of thecalls below.In the case of this participant, the following phone discussions and email exchanges took place duringNovember 2013 – April 2014.· November 19, 2013 participant called and inquired about the amount that was due forDecember premium. She also inquired if she would be able to keep just vision and dentalcoverage. She was informed that we would need something in writing stating that she wants todrop the medical coverage and keep the vision and dental.· December 4, 2013 participant called and explained that she was trying to get Obama Care anddoes not yet want to drop her medical coverage. She was informed that she should send anemail stating that she does not want to drop her medical coverage.