Loudoun County Public Schools Flexible Benefits Account

CompuSys/Erisa Group Inc. Founded in 1968 Licensed Third Party Administrator Administer Flexible Benefits Compensation

Introduction Continuity Great Service New Options Over 99% claims turn-around within 5 days with 100% financial accuracy New Options FSA debit card Direct Deposit of reimbursement accounts Weekly check runs Dedicated internal website for 24/7 online access to account balance, claim history, claim submission, and additional FSA Information Loudoun County Public Schools has offered you excellent service during their tenure administering your Flexible Benefits Plan. We would like to continue offering you the same great service while introducing several new services for you. CompuSys/Erisa offers you the option of using a debit card to pay for eligible flex expenses so that you do not have to pay out of your own pocket. If you choose to file a claim you now have the option of having your reimbursements sent directly to your bank account. In addition, CompuSys/Erisa processes claims on a weekly basis, so you will receive payment quicker. Also for your convenience you will have the option to file claims online.

Benefits Debit Card

The Flexible Benefits Debit Card is a special purpose MasterCard® that gives you an automatic way to pay for qualified healthcare expenses from your Flexible Benefit Plan. It works like a MasterCard® Card, with the value of your yearly target amount stored on it.

What happens when I receive my Benefits Card? You will receive one card, though you may request another. Your card will be activated with the first swipe of the card. There will be no fees associated with the card. You will receive one card. In your enrollment verification packet, you will receive a form to request one additional card for a spouse or a dependent. If you or an authorized card holder loses or accidentally destroys a card, contact CompuSys/Erisa Group Inc. immediately so that we can turn off your current card and issue a replacement card. A $1.00 fee will be deducted from your FSA account to replace each lost, stolen or destroyed card. Activating your Flexible Benefits Debit Card Your Flexible Benefits Debit Card is activated on the first swipe of the card.

How Do I use my card? It works like a MasterCard® Card, with the value of your yearly target amount stored on it. It's from that total target dollar amount that eligible expenses will be deducted as you use your card. When you have eligible expenses at a business that accepts MasterCard®, simply use your Card. The amount of your eligible purchases will be deducted automatically from your account and the pre-tax dollars will be electronically transferred to the provider/merchant for immediate payment.

Where can I use my Benefits Card? For prescriptions at a chain pharmacy or grocery store. At a hospital or doctor’s office (After you use your card you will receive a documentation request for anything other than a co-pay). At a dentist office (After you use your card you will receive a documentation request). At your vision care provider (After you use your card you will receive a documentation request).

Documentation Requests In order to verify that you have used your card for items that are eligible under your flex plan you will receive a letter from us asking for supporting documentation. After you receive a request for documentation please mail, fax or email back the requested information along with the letter. The following slides outline acceptable forms of documentation. Several weeks after you’ve used your Flexible Benefits Card, you will receive a letter in the mail asking for you to provide documentation that shows that your debit card charge was an eligible expense. Please mail back the letter, in addition to either an itemized receipt, Explanation of Benefits (EOB) from your insurance company, prescription tags, or an itemized cash register receipt.

Medical/Dental For doctor or dentist visits, an EOB is the preferred form of documentation. If you do not have a copy of the EOB, please obtain an itemized bill from the provider that clearly shows the date of service, patient, provider name, insurance payments/write offs, and the service provided. For co-pays the bill must indicate the date of service, patient, provider name and co-pay amount.

Vision Care For Vision care, please provide an itemized bill that has the patient name, description of the service provided, the cost of the service provided, the date of service and the provider name.

Prescriptions For prescriptions, please provide a copy of the prescription tag that indicates the patient name, when the prescription was filled, the name of the prescription, the pharmacy name and the cost of the prescription.

Over the Counter Items For non-medicinal over the counter items, please provide a cash register receipt that shows the date of purchase, name of item purchased and the store name. You will not be able to use your Debit Card to purchase medicinal over the counter items.

What happens if I am unable to submit the requested documentation? You can pay back your account by sending a check to CompuSys/Erisa. You can submit offsetting documentation. You will have 45 days to submit the requested documentation, pay back your account, or submit offsetting documentation. If you are unable to obtain the requested documentation, or if you accidentally use the card for an item that is not eligible under your flexible benefits plan you have several options: You can pay back your account by writing a check to CompuSys/Erisa and your account will be credited back this money. Your other alternative would be to submit documentation for another expense that you have paid for out of your pocket that is eligible under your flexible benefit plan. You will have 45 days to submit the requested documentation, pay back your account, or submit offsetting documentation. If after 45 days you have not submitted the requested documentation then your card will be suspended pending receipt of the documentation.

Are there places the Prepaid Benefits Card won’t be accepted? Your card will not be accepted at locations that do not offer eligible goods and services, such as hardware stores, restaurants, bookstores, gas stations and home improvement stores.

If asked, should I select “Debit” or “Credit” The Card is actually a prepaid Card. But, since there is no "prepaid" selection available, you’ll select "Credit." You do not need a PIN and you cannot get cash with the Prepaid Benefits Card.

Account Balance How do I know how much is in my account? You will receive quarterly statements from CompuSys/Erisa. You can log on to your account at lcpsflex.com. You can call CompuSys/Erisa to obtain your current balance. What if I go over my account balance? If you try to make a purchase that is over your account balance the transaction will be denied for insufficient funds. Your purchase cannot exceed the amount of money currently in your Flexible Benefit Plan.

I received an old medical bill can I use my card to pay for it? You can only use your card for expenses in the current plan year. If you receive a bill in 2011 for an expense that incurred in 2010 you can’t use your card to pay the bill. If you are new to the plan and use your card to pay for a bill before you enrolled in the plan, you can’t use your card to pay the bill. If you do use your card to pay for a bill for a previous plan year, or prior to your enrollment in the plan, you will be require to pay back your account. As long as the respective employee benefit account's) remain part of your benefit plan and you elect to participate each year, your Prepaid Benefits Card will be loaded with your new annual election amount at the start of each plan year. After three years you will automatically be issued a new card as long as you are still enrolled in the benefits plan.

What can I do on lcpsflex.com? The lcpsflex.com website allows you to : Under the heading Forms, print out claim forms and print out direct deposit authorization forms. Under the heading Eligible Expenses, you can verify whether something will be reimbursable under your Flex Benefit Plan. Have basic questions answered about your Flexible Benefit Plan under the Q&A. Have basic questions answered about your debit card, under the heading Flexible Benefits Card. File a claim online.

Claims

How to file a Claim To obtain a claim form: Log on to lcpsflex.com and look under the heading Forms Call 1-800-933-7472 to request claim forms All of our communications to you will include a claim form along with a return envelope. The claim form has a carbon copy attached so that you may retain a copy for your records. If you do not have a physical copy you may log onto lcpsflex.com, click on the word forms, and print out the Loudoun County Public Schools Claim form. The claim form is a word document, so you can type directly on the claim form, however make sure you actually sign and date the claim form in ink. If you do not have computer access you may call us at 1-800-933-7472 and we will mail a claim form to you.

When filing your claim, please make sure that: You have included your PID issued to you by Loudoun County Public Schools. You have made copies of all of your receipts for your own personal records. You have verified that each line item on the claim form corresponds with a receipt/ Explanation of Benefits/itemized bill that you are submitting. Each bill states the patient name, the date of the visit, the provider of the service, cost of the service, and insurance payment. The bill shows actual insurance payments, not pre-estimates. You include a letter of medical necessity from a doctor for medicinal over the counter items.

Each dependent care bill states the dates of service, service provider, service provider tax id, and amount charged. If you do not have an itemized bill from your Dependent Care Provider, have your Dependent Care Provider complete the Dependent Care portion of the claim form. You include the date of birth of your child when filing for dependent care. You, the employee, have signed and dated the claim form.

Claim filing options You may mail a claim to: CompuSys/Erisa at : 12325 Hymeadow Dr., Bldg 4-100 Austin Texas 78750 You may fax a claim to CompuSys/Erisa at 1-512-250-9487. You may send an email with your claim as an attachment to CompuSys/Erisa at flex@cserisa.com. You may file a claim online at lcpsflex.com

To File an Online Claim Log on to the lcpsflex.com website. Click on My Account, and then enter your Employee PID issued by Loudoun County, and the PIN issued to you by CompuSys/Erisa

You will come to the Balances page, click on Personal Information and enter in all of your dependents. Please note all of the headings on the top of the screen, you are now at the Balances page. Click on Personal Information, your name and address will already be filled in, if you would like to receive correspondence by email please enter your email address. Enter in all of the information for your dependent and click submit. After you have entered in the information for each dependent. Click on Claim at the top of the page.

Look at the top and click on Claims, then look to the top left and click the File a Claim Button. The top section of the page is for healthcare reimbursement requests. Fill in the dates of service, patient name, service provider, and amount of reimbursement for each itemized bill that you are attaching.

The bottom section of the page is for Dependent Care claims The bottom section of the page is for Dependent Care claims. Make sure to fill in all of the fields for each dependent.

After you’ve read the Employee Certification message click the I Agree Button. Use the Browse button to upload your itemized bills. Make sure the attachment you upload is no bigger then 10 Megabytes. Once you’ve uploaded all of your attachments, click the Submit button.

The Website Even though it says the card is good for five years on this webpage, the new 2011 card is actually only good for 3 years. This notice should be changed in time for us to be able to change the slide for the presentation.

What else can I do on the website? In addition to filing a claim, you can view your balance. Look at all of your payroll deductions.

View your claims history. Look at your payment history.

Questions If you have any additional questions, please contact CompuSys/Erisa at 1-800-933-7472. You may also email us at flex@cserisa.com.