Claims Submission
Our Flexible Benefit Plan claims submission process is easy for you! Obtaining a claim form online is an excellent way to manage your healthcare dollars, plus, it speeds reimbursement.
- Go to www.innovaben.com/employees and click on “Forms” to download our Flexible Benefit Plan Claim Form.
- Complete the form in its entirety. If you require multiple forms, feel free to attach a spreadsheet listing all required information.
- If you are logged into your account, you can use "Online Claims Entry" for your convenience. This type of claim form enables an email reply once your claim is received by our office.
- Print the Claim Form. Be sure to sign and date it.
- Gather all detailed receipts and documentation for the items you listed on the claim form. Receipts must include date of service, type of service, patient name, amount charged by provider, and, amount paid by insurance, if applicable (see Acceptable Documentation section).
- You may submit your claims online via secure file upload (FilesAnywhere link) at Claims Submission. Click on the link and follow the instructions.
- Or, fax the claim form and all receipts to us at 877-774-1328. (Please be sure that all receipts are legible.)
It’s that easy!!!
If you prefer the traditional claims submission method, you may submit your claims by completing a claim form, and sending it to us (with all applicable receipts) via postal mail or fax.
ACCEPTABLE DOCUMENTATION
The Internal Revenue Service guidelines governing flexible spending accounts and dependent daycare accounts are very specific regarding what type of documentation is allowed as substantiation for an eligible expense. Cancelled checks or charge card receipts do not meet the IRS guidelines.
FOR MEDICAL REIMBURSEMENT, if you have insurance coverage, the expense should first be filed with your medical, dental, or vision insurance carrier. After you receive the Explanation of Benefits (EOB) form you may submit that as documentation for your claim. The EOB contains the required information.
Other acceptable documentation would include a detailed receipt from the service provider showing date of service, type of service, patient name, amount charged, and amount paid by insurance, if any.
For prescription drugs, the pharmacy receipt (not the cash register receipt) is acceptable. The pharmacy receipt will show the patient name, date, name of prescription, and cost. Or, you may periodically submit a printout provided by the pharmacy.
If no receipt is available, the Medical Expense Certification Form found in our Forms Library is acceptable. This form must be completed by your medical care provider.
For reimbursement of orthodontic expenses, you must provide a copy of the orthodontic contract. Orthodontic treatment may take up to two years or more, and reimbursement of the entire expense up front could violate the requirement that the expenses be incurred during the period of coverage. However, each case is reviewed on an individual Plan’s practice basis. Refer to the Flexible Benefit Plan Frequently Asked Questions for further guidance.
FOR DEPENDENT DAYCARE EXPENSES, an itemized statement from the daycare provider showing the dates of service, name of dependent, cost of care, and name of the care provider.
If no receipt is available, the Dependent Care Expense Certification Form found in our Forms Library is acceptable. This form must be completed by your daycare provider.
CERTIFICATION OF MEDICAL NECESSITY
IRS guidelines prohibit the reimbursement of some health care services and products unless those services and products are recommended or prescribed by your doctor to treat a specific medical condition; in other words, they must be deemed “medically necessary”.
Your healthcare provider may submit a statement on his/her letterhead indicating the medical necessity of the service or product. The statement must also include the specific medical condition for which it is needed.
You may also have your healthcare provider complete the Certification of Medical Necessity Form found in our Forms Library. This form must be completed by your healthcare provider.
The Certification of Medical Necessity Form will become increasingly important due to the Health Care Act’s elimination of automatic eligibility of over-the-counter items, effective January 1, 2011.