If she does not enroll in an FSA for the next plan year, the $100 will be forfeited because it is below the $120 minimum. Between $120 and $640 remaining Jerry has $150 left in his Limited Purpose FSA on December 31 (between the carryover minimum and maximum amounts). If he enrolls in a Limited Purpose FSA, the $150 will carry over and be added to his Limited Purpose FSA election for the next plan year. If he does not enroll in an FSA, the $150 will still carry over to establish a Limited Purpose FSA for his use in the next plan year. Over $640 remaining Taylor has $690 left in their Limited Purpose FSA on December 31 (over the $640 maximum that can be carried over). If they enroll in a Limited Purpose FSA, $640 of the $690 will carry over and be added to their Limited Purpose FSA election for the next plan year; the remaining $50 will be forfeited. If they do not enroll in an FSA, $640 will still carry over to establish a Limited Purpose FSA for their use in the next plan year. How do I receive information from Navia Benefit Solutions? You can choose your method of communication. For example, if you provide an email address, statements and other communications will be sent automatically to your email. You may change your method of communication or opt out of email delivery either online or by contacting Navia Benefit Solutions directly at any time. The Navia Benefits Debit Card This debit card is a convenient way to pay for eligible out-of-pocket dental and vision expenses for you, your spouse or SRDP, and your qualified dependents. Participating merchants using the Inventory Information Approval System (IIAS) can accept this card. You can find a list of IIAS participating merchants at pebb.naviabenefits.com. Rather than filing a claim and waiting for reimbursement for your out-of-pocket eligible expenses, you can use the debit card at participating merchants to pay your provider directly. The expense is deducted from your Limited Purpose FSA balance. This system allows Navia Benefit Solutions to electronically substantiate the eligibility of your expense. However, the IRS has strict regulations about where the debit card can be used and when follow-up documentation is required for transactions that can’t be substantiated electronically. Using the debit card does not eliminate the need to submit follow-up documentation when requested by Navia Benefit Solutions. If any of your debit card charges do require substantiation, you will receive a summary of your card activity for those charges from Navia Benefit Solutions at the beginning of each month. We recommend you always save all your receipts and documentation. If you use the debit card for an ineligible expense, you must either repay the amount of the ineligible expense back to Navia, or request the substitution or offset of future claims to repay the amount. Navia Benefit Solutions will reactivate the debit card once you reimburse the account for the ineligible expense. If you do not, the card will be suspended after 75 days to prevent further use and will remain suspended if the expense is no substantiated or repaid by the end of the plan year. You may still submit claims by email, mobile app, fax, or mail. You must provide a valid email address to receive the debit card when you enroll. Debit card requests You may request a debit card when you enroll or through the Navia Benefit Solutions website. You may request additional cards at no cost. If your debit card is lost or stolen, contact Navia Benefit Solutions immediately so we can help protect your account from unauthorized transactions. IIAS and participating merchants You can use the Navia Benefits Card at IIAS-participating merchants and medical care merchants using the MasterCard® system. The IIAS system recognizes most eligible Limited Purpose FSA expenses. 7
Limited Purpose FSA Enrollment Guide Page 6 Page 8