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7701 Thorndike Rd.
Greensboro, NC 27409
336-665-9400

 
On-line Inquiry System

CLIENT
BROKER
EMPLOYEE
PROVIDER
PPO
EDI TRANSACTIONS
FLEXIBLE SPENDING

 


For account maintenance, account balance inquiries, and online claim submission.  Click here to go to the Penn Western Flexible Spending Account Page

FSA Request & Substantiation Form

 

General Information

  1. Benefits for the Employer

  2. Benefits for the Employee

Flexible Spending Account FAQs

  1. What is a Flexible Spending Account Plan (or FSA)
  2. Do I have to enroll each plan year
  3. Why should I participate in a Health Care Flexible Spending Account
  4. Can I submit over-the-counter drugs for reimbursement
  5. What if I currently take the dependent care credit on my annual tax return
  6. Can I change my contributions during the year
  7. Can I participate in a FSA if I am not covered under my company’s health care plan
  8. What if I don’t use all of the money I set aside in my account(s)
  9. Do I have to wait for money to be deposited into my account in order to make a claim
  10. How do I know how much is available in my account(s)
  11. What is the maximum amount that I can contribute to my FSA
  12. How do I obtain reimbursement for eligible expenses
  13. If I elect too much for my medical FSA, can I transfer excess to dependent care
  14. Who should I contact if I have questions
Debit Card FAQs
  1. What is the SmartFlex Debit Card
  2. Where can I use the card
  3. What are some of the advantages of using the debit card
  4. Is a PIN number required
  5. When will my card be activated
  6. What if the location where services are being performed doesn’t accept VISA cards
  7. Do I need to submit documentation for all debit card purchases claims
  8. What should I attach to my claim form when submitting documentation
  9. Should I wait to submit documentation until I am notified to do so
  10. If I’m buying two prescriptions at once, should I swipe my card for each separately
  11. What happens if my debit card transaction exceeds the available balance
  12. What if I use my card for ineligible expenses by accident
  13. Can I order an additional card for my spouse or dependent(s)
  14. Will my card expire at the end of the FSA plan year
  15. Can I use my card this plan year for expenses incurred in the prior plan year
  16. If I terminate employment, can I continue to use the debit card

 

Benefits for the Employer:

Reduced FICA taxes resulting from reduced gross pay taxes. Employer FICA taxes at 7.65 percent can be significant.

Allows the Employer to actually increase the employee’s take-home pay without increasing gross wages - a valuable tool in times of stagnant wages.

Enhances the overall benefits package, thereby improving employee recruitment and retention.

 

Benefits for the Employee:

Provides significant tax savings for employees, thus translating into more take-home pay which results in greater job satisfaction.

An FSA plan can cushion the financial impact to employees that results from increasing health care premiums.

 

What is a Flexible Spending Account Plan (or FSA)?

 An employee benefit program that allows you to set aside money, on a pre-tax basis, to pay for certain out-of-pocket health care and dependent care expenses. Because the money goes into your account(s) before federal income or Social Security taxes are withheld, you pay less in taxes, and have more disposable income.  Your money is also exempt from state income taxes in most states.

  

Do I have to enroll each plan year?

 Yes, you must make an election prior to the beginning of each plan year.  Your employer will provide instructions on this procedure.  The amount you elect will be automatically deducted from your paychecks during the plan year and credited to your FSA account(s).

  

Why should I participate in a Health Care Flexible Spending Account when I already have health care coverage?

 Most health care plans have some co-payments and/or deductibles in addition to non-covered services.  You will be able to use your flexible spending account for these types of expenses.

 

 Can I submit over-the-counter drugs for reimbursement?

 You can submit over-the-counter drugs that are medically necessary such as allergy medications, aspirin, antacids, and cold medicines.  Amounts paid for items that are merely beneficial to general health are not eligible for reimbursement. 

 

 What if I currently take the dependent care credit on my annual tax return?

 You cannot use both the dependent care FSA contributions and the income tax credit for the same expenses.  The amount you deposit into your Dependent Care Account reduces the amount, dollar for dollar, that you can claim as a credit on your tax return. 

 Deciding whether to participate in the Dependent Care Account depends on your income, income of your spouse, filing status, number of dependents and annual dependent care expenses.  Please consult a tax professional for advice.

 

Can I change my contributions during the year?

 Only if you have a qualified status change such as marriage, divorce, birth or adoption of a child, death of a dependent,  or a change in your or your spouse’s employment status.

  

Can I participate in a flexible spending account if I am not covered under my company’s health care plan?

 Yes, you can still participate in the flexible spending account.

 

 What if I don’t use all of the money I set aside in my account(s)?

 Any contributions not used during the plan year cannot be rolled over or refunded to you (sometimes referred to as the use-it-or-lose-it rule).  Most plans have a year-end grace period determined by the employer to allow for time to submit all claims.

 

 Do I have to wait for money to be deposited into my account in order to make a claim for reimbursement?

 Health Care Account – your election amount is available to you as of the beginning of the plan year.  This means that you may receive reimbursement for eligible expenses in excess of your payroll contributions to date. 

 Dependent Care Account – you are reimbursed only up to the amount of your payroll contributions to date.

  

How do I know how much is available in my account(s)?

 Each time you receive a reimbursement, a statement attached to your check will show your annual election amount as well as claims submitted to date.  You may also check your account online at www.pennwestern.com.

  

What is the maximum amount that I can contribute to my Flexible Spending Account(s)?

 The maximum contribution for the Health Care Reimbursement Account is determined by your employer.

 The maximum contribution for the Dependent Care Reimbursement Account is determined by the following IRS rules. 

  • If you are married, both you and your spouse are employed and you file a joint income tax return, or if you are a single parent, the maximum you can contribute is the least of your earned income, your spouse’s earned income, or $5,000.
  • If you are married and you and your spouse file separate income tax returns, the maximum is $2,500.

 If a spouse also participates in a Dependent Care Assistance Account, the maximum is $5,000 combined for both accounts.

 In the case of a spouse who is a fulltime student at an educational institution or is physically or mentally incapable of caring for himself, such spouse shall be deemed to have earned income of not less than $250 per month if the Participant has one dependent and $500 per month if the Participant has two or more dependents.

  

How do I obtain reimbursement for eligible expenses?

 You must complete a request for reimbursement form available at www.pennwestern.com and submit it to Penn Western Benefits along with copies of bills, receipts, explanation of benefits from your health care plan, etc.  Documentation must include date of service, type of service, and amount of charges.  Copies of cancelled checks, credit card receipts, or balance forward statements are not adequate proof of claim.  You may mail, fax, or e-mail your request to flex@pennwestern.com.  You may also enter your claim online at www.pennwestern.com.  You may use your debit card if your employer’s plan offers this option.

You do not have to pay for services before being reimbursed, but the expense must have been incurred during the plan year period for which your election was made.

  

If I elect too much for my medical FSA, can I transfer excess to my dependent care FSA? 

No, you can use monies only for the purpose for which your election was made.  Monies cannot be transferred between accounts.

  

Who should I contact if I have questions?

 You can speak with your employer’s human resource representative, or contact Penn Western Benefits at (336) 665-9400; fax (336) 664-1300; or visit our web site at www.pennwestern.com.

Debit Card FAQs

 

Penn Western Benefits offers employers the option of providing a Debit Card to employees who are participating in Flexible Spending Accounts.  The card can be used to pay for eligible medical and dependent care expenses.  Some examples of eligible expenses are medical deductibles, co-payments not covered by a health plan, prescriptions, dental or vision related expenses, eligible over-the-counter items, and dependent day care expenses.

 

What is the SmartFlex Debit Card?

It is a debit card that simplifies the process of paying for eligible expenses through your Flexible Spending Account Plan (FSA).

 

Where can I use the card?

 You can use the card at qualifying merchant locations wherever VISA is accepted.  Eligible merchants include doctor and dentist offices, in-store pharmacies, vision service locations, medical clinics, hospitals, and dependent care providers.

  

What are some of the advantages of using the debit card? 

  • Immediate access to FSA funds – you avoid having to pay with cash or check
  • Immediate payment of expenses – you avoid waiting for a reimbursement check
  • Funds are transferred directly from your FSA to the provider
  • Reduces the amount of manual claims submission
  • Access to claims and balance information online

  

Is a PIN number required? 

No. Although this is a debit card, because it is an off-line debit card, it is treated like a credit card at point of sale.  A PIN NUMBER IS NOT REQUIRED FOR THIS CARD.

  

When will my card be activated? 

Your card will be automatically activated the first time you use it for an eligible expense. 

 

What if the location where services are being performed doesn’t accept VISA cards? 

You should submit the claim manually as you do other non-debit card purchases. 

 

Do I need to submit documentation for all debit card purchases claims? 

Documentation should be submitted for all claims except  

  • Expenses that match your employer’s medical plan doctor office visit co-pay(s)
  • Prescription co-pays

 

YOU MUST KEEP ALL RECEIPTS. 

 

What should I attach to my claim form when submitting documentation for debit card purchases? 

You should submit copies of bills, receipts, explanation of benefits (EOB) from your health care plan, etc.  Documentation must include date of service, type of service/item purchased, and amount of charge.

  

Should I wait to submit documentation until I am notified to do so? 

No, documentation should be sent to Penn Western Benefits by mail, fax, or e-mail immediately in order to prevent possible suspension of your card usage.  flex@pennwestern.com

  

If I’m buying two prescriptions at once, should I swipe my card for each separately? 

Yes.  If you are buying two or more prescriptions, or have two or more doctor visit co-pays, have your doctor’s office or pharmacy swipe your card for each family member visit or prescription individually.

  

What happens if my debit card transaction exceeds the available balance in my FSA account? 

If your available balance is less that the expense you are charging, the entire charge will be denied.  You can avoid this by paying for the difference by check, cash, etc. and then have the provider swipe your card in the amount of your available balance.

  

What if I use my card for ineligible expenses by accident? 

You should contact Penn Western Benefits immediately and make arrangements to pay the money back.

  

Can I order an additional card for my spouse or dependent(s)? 

Yes. Cards are available for dependents.  The dependent’s name and social security number are required.  Additional cards cost $5.00 each, and this fee will be charged to your FSA account.

  

Will my card expire at the end of the FSA plan year? 

No.  Your card will expire three years from date of issue.  

 

Can I use my card this plan year for expenses incurred in the prior plan year? 

No.  You will be able to use the card only for expenses incurred within the current plan year.  Once a plan year has ended, you will need to submit claims for the prior year manually by mail, fax, or e-mail.

  

If I terminate employment, can I continue to use the debit card? 

No.  The card is deactivated at that time. You should file claims manually for eligible expenses that were incurred during your period of coverage.