Claims submission and reimbursement
How can I access the money in my flexible spending account (FSA)?
You can access your general purpose health care FSA funds by:
- Mailing or faxing the FSA claim form.
- Submitting claims online.
- Accessing the free PayFlex Mobile® app to submit claims and receipts on the go.
- Using the Auto Pay process.
- Using an FSA debit card for prescription copays, coinsurance, and eligible over-the-counter expenses.
Note: The Auto Pay process and debit card cannot be used if you elect the Limited health care FSA.
What is the deadline for incurring expenses that can be reimbursed through an FSA?
If you are enrolled in the FSA as of December 31 of the plan year, you can incur expenses to be reimbursed from each year's FSA until March 15 of the subsequent year. Funds not used by this date will be forfeited. For example, if you have an FSA for the current plan year, you will have until March 15 of the subsequent plan year to incur expenses as long as your FSA benefit was still active on December 31 of the current plan year.
What is the deadline for submitting a health care claim for reimbursement?
The deadline for submitting a claim for reimbursement of each year's FSA-eligible expenses is May 31 of the subsequent year. Note: May 31 is the date by which the request must be received, not the postmark date.
What if there are funds remaining in my FSA for the prior plan year and I begin contributions to account for the current plan year?
At the beginning of the year, any funds remaining in your prior plan year account will be used first to reimburse expenses incurred prior to March 15 of the current plan year, until the funds are exhausted or the deadline to make a claim has passed. Eligible expenses incurred after March 15 will be reimbursed with funds from your current plan year account.
If you were previously enrolled in an Aetna HealthFund and then enroll in the HDHP for the next plan year, you must deplete the balance in your general purpose health care FSA by December 31 to be eligible for HSA contributions on January 1. See Limited health care FSA for more information.
How can I check the account status for claims processed by PayFlex?
What happens to the money in my FSA if I waive coverage during a permitted election change?
You can continue to use the funds remaining in your FSA to pay for eligible expenses incurred prior to the effective date you waived coverage. However, you will not be reimbursed for any expenses incurred after the effective date for which the FSA benefit was waived. You would still have until May 31 of the following year to submit claims for eligible expenses incurred prior to the effective date you waived coverage.
What happens to the money in my FSA if I no longer work for Vanguard?
You can continue to use the funds remaining in your FSA after leaving Vanguard to pay for eligible expenses incurred prior to your termination date. For the health care FSA, you can elect to continue coverage through COBRA and incur expenses through the end of the year. To access the funds, you must first pay for the expense out of pocket, and then you must submit a claim form and receipt for reimbursement. You may submit claims for expenses incurred prior to the termination date until May 31 of the following year.
How do I submit the FSA claim form?
After making an out-of-pocket purchase for an eligible health care expense, mail or fax the completed FSA claim form to PayFlex along with an itemized receipt, statement, or Explanation of Benefits (EOB). Once the request for reimbursement is approved, the money will be issued by check or direct deposit to your authorized bank account.
How do I submit a claim online?
Access the PayFlex or Aetna Navigator website.
Under Financial Center, choose File a Claim. You can request reimbursement and upload an itemized receipt, statement, or Explanation of Benefits (EOB). Once the reimbursement request is approved, the money will be issued by check or direct deposit to your authorized bank account
Can I submit claims through a mobile app?
Yes, you can submit claims through the free PayFlex mobile app. The app is available for iPhone and iPad mobile digital devices, as well as Android smartphones.
How do I enroll in or change my direct deposit information?
To enroll in or change your direct deposit information, complete the Direct deposit authorization form, or log on to the PayFlex website, click Financial Center, and select Enroll in Direct Deposit.
How does the PayFlex Auto Pay feature work?
The Auto Pay feature automatically passes medical and dental claims to PayFlex, eliminating the need to submit a reimbursement request.
For example, when you go for a regular office visit, present your Aetna ID card and pay the required deductible or coinsurance. Once the claim is processed, you will be automatically reimbursed (the deductible or coinsurance amount) by check or direct deposit to your authorized bank account.
Note: Orthodontia and vision claims will not be processed through Auto Pay.
The Auto Pay feature is not available if you elect the Limited health care FSA.
Can I opt out of Auto Pay reimbursements?
Yes. You can turn off and turn on Auto Pay reimbursements at any time during the year through the Aetna Navigator or PayFlex website or by calling Aetna. Once Auto Pay is turned off, claim submissions must be made using the FSA claim form. The Auto Pay feature will automatically turn on at the beginning of each new plan year.
Follow these steps for changing Auto Pay reimbursements:
- Log on to Aetna Navigator or PayFlex.
- Click the Financial Center tab.
- From the dropdown menu, select Health Plan Activity.
- Click Health Plan Activity Options on the left side.
- Review and update your current automatic reimbursement settings, then click Save.
I am in the Aetna HealthFund with the health reimbursement arrangement (HRA). If I contribute to an FSA, which account is used first when paying medical claims?
For all medical claims, the money in your HRA will always be depleted first, even if you have a remaining balance in your FSA from the prior year. Once your HRA funds are exhausted, reimbursements will be processed from your general purpose health care FSA.
How do I submit a claim for orthodontia expenses?
You must submit the FSA claim form and receipt of payment to PayFlex. Orthodontia claims will not be reimbursed through Auto Pay.
If I'm a U.S. citizen working outside of the United States, can I receive reimbursement from my health care FSA?
Yes, your eligible health care expenses are reimbursable. Simply submit the FSA claim form. If you pay in foreign currency, please indicate the currency so PayFlex can complete the conversion.