National Health Care Reform Changes
What changes can I expect to my health care reimbursement account as a result of the recently passed health care reform laws?
- In order to be reimbursed for over-the-counter (OTC) drugs and medicines from your health care reimbursement account, you must provide a doctor's prescription.
- A new category of "adult child" has been added as an eligible individual under the health care reimbursement account. As a result, eligible expenses incurred for your adult child up to their 26th birthday will be reimbursable under your health care reimbursement account. The adult child does not have to live with you and may be married or unmarried.
When did these changes go into effect?
January 1, 2011.
When and Where You Can Use the WageWorks Card
When can I use the card?
You can use your WageWorks health care card beginning January 1 of the plan year, if you enrolled in a Health Care Reimbursement Account during Open Enrollment. Otherwise, you may begin using your card effective with your enrollment in a Health Care Reimbursement Account and receipt and activation of the card. You can use the card until December 31 of the plan year, to pay for eligible expenses you or your eligible dependents incur during the plan year. Your card is a three-year card and expires on the date printed on the card. Therefore, please do not discard the card even after depleting all funds in your account. If your card is due to expire at the end of a year and you have re-enrolled, you will receive a new card in the mail before January 1.
Where can I use the card?
You can use your WageWorks health care card at doctor and dentist offices, vision centers, IIAS-certified pharmacies, and other health care-related merchants who accept Visa® debit cards. Below is a chart of typical merchant types: Card payments at all other merchant categories (including restaurants, entertainment and travel) are prohibited and automatically declined through the card network when authorization is attempted.
- Ambulance Services
- Counseling Services
- Dental, Medical Lab
- Dentist, Orthodontist
- Drug Proprietors
- Health, Med Services
- Hearing Aid Sales
- Nursing, Personal Care
- Orthopaedic Goods
- Osteopathic Physician
- Wholesale Medical Equipment
Can I use the card at pharmacies?
Only pharmacies that are IIAS-certified will accept the health care card. IIAS is an inventory system used by retailers to ensure that health care reimbursement account cards are being used only to purchase eligible expenses. Every item in the store's scanner database is flagged "yes" or "no" for plan eligibility. Most large pharmacy chains are currently IIAS certified. Local merchants and pharmacies in the Triangle that are IIAS- certified include Duke Pharmacies, Walgreens, Wal-Mart, Sam's Club, Target, CVS, Kerr Drugs, Rite-Aid, Harris Teeter, Food Lion, Costco Wholesale and Kroger. For a full list of IIAS-certified merchants, click here.
Can I use my health care card with the pharmacy mail order program (Express Scripts)?
Yes. You can use your health care card with the pharmacy mail order program. Just provide the account number from your card to Express Scripts. Receipts will not be requested by WageWorks for expense verification. However, you should always keep a copy of your receipts for IRS purposes.
Can the health care card be used outside of the United States?
The health care card can be used internationally as long as the provider operates under an eligible merchant category code. Depending on the provider and the transaction, the expense may have to be verified with receipts or other documentation. If you make a purchase in a currency other than the currency in which your card was issued, the amount deducted from your funds will be converted by Visa USA Inc. into an amount in the currency of your card. In this case, the issuer reserves the right to increase the currency conversion rate by an additional 3% and will retain this amount as compensation for its services.
Can I use my card to pay my online medical bills?
You can use your health care card to pay online medical bills if you are able to provide documentation to WageWorks that details exactly what service/expense you paid for with the card.
Over-the-Counter (OTC) Drugs and Medicines
Can I use my health care card to purchase over-the-counter (OTC) medications?
As of January 1, 2011, you will need a doctor's prescription to purchase OTC drugs and medicines, such as Claritin, Advil and Robitussin, through your health care reimbursement account.
Since the law requires a prescription for OTC drugs and medicines to be eligible for reimbursement under your health care reimbursement account, you will no longer be able to use your health care card to pay for these purchases.
You will have to provide another form of payment when purchasing OTC drugs and medicines, even if you have a doctor's prescription.
Will I need a prescription to purchase OTC drugs and medicines?
If you want to be reimbursed for an OTC drug or medicine under your health care reimbursement account, a doctor's prescription will be required in order to process the reimbursement.
What are some examples of OTC drugs and medicines that require a doctor's prescription to be reimbursed through my health care reimbursement account?
OTC drugs and medicines include, but aren't limited to: cough, cold and flu medicines, stomach remedies, antibiotics, pain relievers, digestive aids, allergy and sinus medicines and sleep aids. As a general rule, any OTC drug or medicine that you take orally or topically will require a prescription.
Will I have to submit a doctor’s prescription to WageWorks each time I file a Pay Me Back claim for reimbursement of an OTC drug or medicine?
Yes. Currently WageWorks does not have a way to keep prescriptions, letters of medical necessity, or other notes. Therefore, keep a copy of the prescription for each claim submission.
Does the prescription requirement apply to other OTC health care items?
The prescription requirement applies only to OTC drugs and medicines. You will still be able to use your health care card at pharmacies and stores to pay for prescriptions, insulin, medical devices (including crutches and blood sugar monitors), bandages and many other OTC medical items such as hearing aid supplies, foot therapy supplies, contact lens cleaning supplies and reading glasses.
Will I need a doctor's prescription to be reimbursed for my insulin purchases?
No. Insulin receives special treatment and remains eligible for reimbursement without a prescription.
What about the purchases of vitamins and supplements?
Because vitamins, minerals and other supplements already require additional documentation from a physician to be reimbursable, the existing documentation requirements for these expenses should not change based on the new law.
My doctor wants me to take an aspirin each day. Can I be reimbursed for this OTC purchase?
Yes. The law specifies that OTC drugs and medicines, including common pain relievers such as aspirin, will be eligible for reimbursement with a doctor's prescription.
If I have a doctor's prescription for drugs and medicines such as aspirin, Claritin, Advil, or Robitussin, how do I get reimbursed for these purchases?
Since you are unable to use your health care card to pay for OTC drugs and medicines, you will be required to submit the receipt showing the purchased items along with your doctor's prescription, through a Pay Me Back claim online, through the new EZReceipts App for mobile phones, or by fax or mail. You may download a Pay Me Back claim form here.You may access your WageWorks account to file an online Pay Me Back claim.
Is there a complete list of OTC items that do/do not require a doctor's prescription?
The following categories of items require a doctor's prescription in order to be reimbursed under your health care reimbursement account and thus, cannot be purchased using your WageWorks health care card:
- Acid Controllers
- Allergy & Sinus
- Antibiotic Products
- Anti-Itch & Insect Bite
- Anti-parasitic Treatments
- Baby Rash Ointments/Creams
- Cold Sore Remedies
- Cough, Cold & Flu Digestive Aids
- Feminine Anti-Fungal/Anti-Itch
- Hemorrhoidal Preps
- Motion Sickness
- Pain Relief
- Respiratory Treatments
- Sleep Aids & Sedatives
- Stomach Remedies
The following are examples of some of the items that remain available for reimbursement without a doctor's prescription and thus, can be purchased using your WageWorks health care card:
- Band Aids
- Birth Control
- Braces & Supports
- Contact Lens Supplies & Solutions
- Denture Adhesives
- Diagnostic Tests & Monitors Elastic Bandages & Wraps
- First Aid Supplies
- Insulin & Diabetic Supplies
- Ostomy Products
- Reading Glasses
- Wheelchairs, Walkers, Canes
At the Point of Sale
Will I have to separate my items at checkout?
At IIAS-certified merchants such as Walgreens, Wal-Mart, Sam's Club, Target, CVS, Rite-Aid, etc., the card will only be accepted for payment of eligible health care items. At these stores, when both health care and nonhealth care items are not separated and the health care card is presented for payment, only those eligible health care items will be paid for on that card. Another form of payment will then be requested for the remaining nonhealth care related items.
How will I know if a merchant is IIAS-certified?
An updated list of all IIAS-certified merchants is available at sig-is.org. Local merchants such as Duke Pharmacies, Wal-Mart, Walgreens, Sam's Club, Harris Teeter, Target, Kroger, Food Lion, Costco Wholesale, Rite-Aid, CVS and Kerr Drugs, are IIAS-certified.
What is the spending limit on my card?
The value on the card at the beginning of the plan year is equal to your Health Care Reimbursement Account annual election. As claims are submitted, the value of the card decreases by the amount of the transaction. If enough eligible health care claims have been incurred, the balance will eventually reach zero.
What happens if I have an expense that is larger than my account balance? Can I still use my card for the amount of the available balance and then use another form of payment to pay for the difference?
If your expense is larger than your account balance, you can use up to the account balance and pay for any remaining difference using another form of payment. If you attempt to pay for any expense that is more than your account balance, the transaction may be declined. If this happens, you can pay with another form of payment and then request reimbursement through the Pay Me Back claim. You will receive reimbursement up to the amount available in your account.
What if the card is declined?
If your WageWorks health care card is declined at the point of sale, please use another form of payment to pay for your eligible health care service or expense. You will be able to submit a claim using:
- a Pay Me Back claim form by fax or mail or
- via the Pay Me Back online claims feature through your online WageWorks account or by using the new EZReceipts app for mobile phones.
Receipts, Requests for Reimbursement, and Card Use Verification
I used the card to pay my doctor, hospital, or dentist. My statement shows that the card was used at a health care provider. Why am I still being asked for receipts?
Some doctors' offices, hospitals and dentists perform services which would be considered ineligible for the health care reimbursement account. Because the IRS requires WageWorks to obtain 100% verification of health care card transactions, they ask for itemized receipts for all transactions which they are not able to automatically approve.
Why is my card suspended?
It is mandatory per the IRS to verify all card transactions and to suspend the card for any unverified card transactions. For those transactions that WageWorks is unable to automatically approve, a request for verification is included with your account statement. This Card Use Verification form details each of the transactions for which WageWorks is requesting itemized receipts.
If, after 90 days from the transaction date, WageWorks has not received the requested receipts, your card will be temporarily suspended. As soon as WageWorks receives the requested receipts and is able to verify the card transactions in question, they will be able to reinstate your card. Please refer to the Cardholder Agreement you received with your Health Care Card, or call WageWorks Customer Service at 877-924-3967 for more information.
How can I get my card reinstated?
Once WageWorks has been able to verify the eligibility of your Health Care Card transactions, your card will be reinstated within 2-3 business days. In order to help WageWorks verify these transactions, you should complete the Card Use Verification form and submit it via fax (877-353-9236) or postal mail (Attn: Claims Administrator, PO Box 14053, Lexington, KY, 40512) along with copies of your itemized receipts for the card transactions listed on the form. You can also upload your receipts or other documentation through your online account or submit these forms through the EZReceipt Application. Please make sure the receipts you submit clearly show the date of service, type of service and the amount you were responsible for paying.
How can I find out what I need to verify?
You can find a list of the transactions for which WageWorks is requesting verification on the Card Use Verification form at the front of your account statement, or in your Account and Card Activity in your online account.
Why did the card work if the transaction needs verification?
WageWorks and its partners have worked hard to make your Card easy to use at health care providers, IRS-approved merchants, and pharmacies. In some instances, the partnerships they've established help them verify prescription transactions after the sale. When receipts are requested, it is usually after a purchase at a pharmacy that does not have an IRS-approved system or at a health care provider, such as a doctor's or dentist's office. Therefore, it is extremely important that you save all receipts as the IRS requires 100% verification of all health care card transactions, and check your account regularly by logging on to your online WageWorks account.
Why should I keep my receipts?
In order to keep this program in compliance with IRS regulations, it is important to make sure the card is used only for eligible expenses. WageWorks is responsible for reviewing all card transactions and verifying that the card is used only for eligible health care products and services. In order to make your card transactions go smoothly, keep your receipt even if your purchase is approved at the checkout counter. Receipts are often requested for dental and vision care expenses, or when health care provider expenses are amounts other than the standard health care provider co-pay. We suggest that you separate your purchases and pay for eligible health care items with your WageWorks health care card, and use another form of payment for everything else.
Why do I need to provide a receipt for some transactions and not for others?
You will be required to keep/provide your receipt(s) depending on where you purchase your eligible health care items. There are certain retailers who are IIAS-certified, which means that particular vendor has a computer system which automatically can determine if your purchases are eligible health care items. Retailers such as Walgreens, Wal-Mart, and Sam's Club are IIAS-certified, so you will not have to submit receipts when using your health care card at these stores. Target, CVS, Kerr Drugs, Rite-Aid, Harris Teeter, Food Lion, Costco Wholesale and Kroger are also IIAS-certified. You will also not have to submit receipts for purchases from Express Scripts Mail Order, Duke Pharmacies, or any health care provider where the expense equals one of Duke's standard co-payments or a multiple of the standard copayment amount.
How do I know if I need to provide a receipt or other documentation to WageWorks?
A Card Use Verification form will be included in your statement each time you have a card transaction with an amount that has not been verified. This form makes it easy to submit receipts or other documentation to verify the eligibility of these expenses and resolve the card transactions. You can check your online account at any time for the latest information. If you have an email address on file, you should also receive an email notification if you have a transaction that needs verification.
What do I do if I lose my receipt?
Your account statement will let you know and explain your options. These options may range from submitting a substitute receipt to paying back your account for the amount of the transaction.
Why didn't I receive a monthly statement in the mail?
You will receive a paper statement only if WageWorks is requesting card use verification. However, you can review your account at any time online.
If I cannot provide a receipt to substantiate an expense, how do I pay back my health care account?
To repay your account, send your pre-populated card use verification form (included in your online account) along with a check made payable to WageWorks in the amount of the unverified expense, to Claims Administrator, P.O. Box 14053, Lexington, KY 40512.
Other Questions About the Card
What should I do if I do not receive my health care card by January 1?
You should first check that you are properly enrolled in a Health Care Reimbursement Account. If you are, then contact WageWorks Customer Service at 877-924-3967.
I enrolled in a Health Care Reimbursement Account as a new hire. When will I receive my health care card?
As a new hire you will receive your health care card within two weeks of your enrollment in a Health Care Reimbursement Account.
What do I do if I lose my card or if my card is stolen?
If you believe your card has been lost or stolen, or that someone has transferred or may transfer money from your card account without your permission, call WageWorks immediately at 877-924-3967. This is the best way to minimize any possible losses.
How do I get additional cards for my spouse and/or dependents?
You can order additional cards for your spouse or eligible dependents. Log in to your account, then click the Health Care tab, and select Request Additional Card. You can then enter the first name, last name, and required security information for each additional cardholder. Additional cards will be issued in the name(s) of your spouse or eligible dependent(s), including your adult children up to their 26th birthday.
Will I get a new card if I re-enroll in a Health Care Reimbursement Account next year?
Your card is a three-year card and expires on the date printed on the card. Therefore, please do not discard the card even after depleting all funds in your account.
Is there a charge for a replacement card?
Can my card be suspended?
Yes, your card can be suspended in certain situations, usually to prevent unauthorized use or misuse of the card, including:
- If there are any health care card transactions that are not verified within 90 days of the transaction
- At the beginning of the next plan year, if you have any amount with Receipt or Repayment Needed from the previous plan year
- The card has been reported lost or stolen, or suspicious activity is observed
- At any time, upon Duke's request
You are encouraged to establish your online account and provide an email address in your profile so that WageWorks can communicate with you regarding time-sensitive information like claims notification and account updates.
What happens if I change my name? Will I automatically be mailed a new card?
Make sure you notify Duke of your name change, and then verify that the information has been updated in Duke's payroll system. Once this has been done, you will need to call WageWorks to request a new card with your updated name.
My spouse and I are both Duke employees. Can we both get health care cards?
Yes. Each eligible Duke employee is able to enroll in a Health Care Reimbursement Account and contribute the maximum of $4,000 per year.
My spouse and I are both Duke employees. Can we enroll in one Health Care Reimbursement Account and get two cards that link to that account, so that we could both pay for qualifying health care expenses from one account?
Yes. Either you or your spouse can enroll in a Health Care Reimbursement Account and request additional health care cards for use by eligible dependents, including your spouse. All additional requested cards will be linked to the same Health Care Reimbursement Account.
Do I have to use the WageWorks health care card to have a Health Care Reimbursement Account?
No. You can still submit claims by downloading and completing a Health Care Pay Me Back claim form, via the online claims feature, by mail or fax, or by using the EZReceipt App for mobile phones. Your expenses will be reimbursed via the method you selected (direct deposit or check) when you created your online WageWorks account. You may submit claims, use the health care card, or do a combination of both to access the available funds in your Health Care Reimbursement Account.
I have a dependent care reimbursement account. Can I use my WageWorks health care card to pay for my dependent care expenses?
No, you cannot use your health care card to pay for dependent care expenses.
Duke Basic Enrollees
I am enrolled in the Duke Basic health plan. Will I receive a health care card?
Yes. All Duke Basic members will receive a health care card. The amount available in your health care reimbursement account depends on the level of coverage you have with Duke Basic. In addition to the amount you may have chosen to contribute to your own Health Care Reimbursement Account, Duke provides $200 for individual, $300 for employee/child, $400 for employee/children, $400 for employee/spouse, or $600 for family coverage with enrollment in the Duke Basic plan.
I am enrolled in the Duke Basic health plan, but I will also have a separate Health Care Reimbursement account. Will I receive two health care cards?
No. The funds contributed based on your Duke Basic enrollment will be combined with the funds from your Health Care Reimbursement Account, so that the total from the two sources will be available to you during the plan year.