If he enrolls in a CDHP and a Limited Purpose FSA, the $250 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 $250 will still carry over to establish a Limited Purpose FSA for his use in the next plan year. The Navia Benefits Debit Card This debit card is a convenient way to pay for eligible out-of-pocket medical expenses for you, your spouse or SRDP,and your qualified dependents. Participating merchants using the Inventory Information Approval System (IIAS) and medical care merchants using the MasterCard® system can accept the debit 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 Medical 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 theineligible 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 not 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. If you enroll in both the Medical FSA and DCAP, the same debit card will work for both benefits. 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 Medical FSA expenses. Purchasing health services and items through these merchants can lower the number of additional substantiation requests. Remember to keep your receipts in case additional proof is requested. Participating merchants generally include: • Provider offices • Dental and vision clinics • Hospitals • Mail order Rx programs • IIAS participating merchants You can find a list of IIAS participating merchants at pebb.naviabenefits.com. 9
Medical FSA Enrollment Guide Page 8 Page 10