What expenses are FSA eligible?

Click here​ for a list of eligible expenses.

How do I file a Flexible Spending Account (FSA) claim?

• Use your Benefits Card as a debit card purchase wherever  MasterCard® is accepted. The money is automatically transferred from your Health FSA account to the merchant.
• QuikClaim Mobile Feature- Submit a claim and supporting documentation of your eligible expense directly from your smartphone!  Go to www.padmin.com on your smartphone and log into your account.
• Online Claim Upload- After making a purchase, log in to your My Benefits account and fill out the online reimbursement form.
• Fax- submit a claim form via toll-free fax to (877) 855-7105.
• Mail- mail a claim form to P&A Group, 17 Court Street Suite 500, Buffalo, NY 14202.

When submitting a claim you must include a receipt/proof of purchase or insurance statement. To receive reimbursement faster, sign up for direct deposit to have your money directly deposited into your designated checking or savings account.

When can claims be submitted for reimbursement?

Claims can be submitted for reimbursement for qualified expenses incurred during the plan year. Each plan allows for a “run-out” period at the end of the plan year, which means that any claims incurred during the plan year can be submitted for reimbursement after the end of the plan year. These expenses MUST be for services performed during your plan year. The typical runout period is 90 days after the end of the plan year. Check with your benefits contact regarding your Employer’s runout period.

If I used my FSA debit card at a hospital or dental office, shouldn’t my claim be automatically approved?

Unfortunately, not all expenses from a hospital or dental office are FSA-eligible. For example, some hospital gift stores sell flowers that could still be coded as “hospital” expenses, and some dental offices provide elective services like teeth whitening that could still be coded as “dental” expenses. Unfortunately, these are not FSA-eligible. By obtaining supporting documentation, we’re able to verify the eligibility of the expense to maintain compliance with IRS regulations.

What type of detail needs to be included in my FSA claim documentation?

The IRS requires that participants provide:
1. Date service was received or purchase made
2. Description of service or item purchased
3. Dollar amount (after insurance, if applicable)
4. Name of merchant/provider

Why do I have to substantiate FSA claims?

The IRS requires participants to provide documentation to make sure the expenses are FSA eligible.

Is MDLIVE safe and private?

Yes, MDLIVE is safe and private. MDLIVE is compliant with HIPAA (Health Insurance Portability and Accountability Act) and will only share your information with your selected provider and pharmacy.

Can a provider prescribe medication as part of an MDLIVE visit?

Yes, if the MDLIVE provider believes medication is warranted, he or she can write a prescription for non-narcotic medications (i.e. no controlled substances), which can be sent directly to the pharmacy of your choice.* As soon your consultation is over, your prescription will be sent electronically to one of over 65,000 pharmacies to choose from. If for any reason your pharmacy is unable to receive e-prescriptions, a traditional prescription is generated for our providers to sign and fax. All prescriptions are fully compliant and include all required information.

* Please note: Some state laws require that a doctor can only prescribe medication in certain situations and subject to certain limitations.

* MDLIVE physicians may not treat any children with urinary symptoms.

* Parents/guardian will be required to complete a different medical history disclosure form for children under the age of 36-months prior to making an appointment with an MDLIVE physician. Children under 36 months who present with fever must be referred to their pediatrician (medical home), child-friendly urgent care center or emergency department for clinical evaluation and care.

Who are the MDLIVE providers?

All MDLIVE providers are U.S. Board Certified and able to treat a wide range of patients and conditions.

Following each consultation, members are given a survey to evaluate their provider and appointment.

The results are analyzed and reviewed for quality assurance and used as part of MDLIVE’s continuous improvement process. Selected provider consultations are also reviewed by MDLIVE’s internal medical board.

Can MDLIVE be accessed on mobile devices?

Yes, MDLIVE can be accessed on most mobile devices with an Internet connection. The MDLIVE Mobile App is available for download in the iTunes Store and the Google Play Store.

Where is MDLIVE available?

MDLIVE is available anywhere in the United States.** MDLIVE’s network of Board Certified providers will be provided to you based on the state you are located. MDLIVE makes sure that each provider is fully licensed to practice medicine in your state.

** In Arkansas and Idaho; an initial visit must be completed via video. After an initial visit, subsequent consultations may be completed via phone.

When is MDLIVE available?

MDLIVE is available 24 hours a day, 7 days a week, and 365 days a year, even on holidays. Use MDLIVE anytime you have a non-emergency medical condition, are unable to see your primary care provider, or when you simply prefer a convenient, cost effective alternative to the emergency room, urgent care center, or clinic.

How do I sign up for MDLIVE and activate my MDLIVE account?

You can easily sign up and activate your account by using one the following methods:

1. Go online and visit: mdlive.com/ect
2. Call our toll free number: (888) 632-2738
3. Download our Mobile App, available on the iTunes store and Google Play.

What non-emergency conditions can an MDLIVE Behavioral Health provider treat?

• • Addictions
  • Stress
  • Bipolar Disorder
  • Depression
  • Eating Disorders
  • Grief and Loss
  • Life Changes
  • Panic Disorders
  • Parenting Issues
  • Postpartum Depression
  • Relationship and Marriage Issues
  • Trauma and PTSD
  • Child and Adolescent Issues
  • Men’s Issues
  • Women’s Issues
  • And more

What Do Commuter Benefits Cover?

There are many options available to help you save while going to and from work every day. These include:

• Mass Transit and Vanpooling. You can use your benefits plan dollars for subway, bus, train and ferry expenses. Just swipe your debit card at one of over 10,000 terminal locations to pay for your transit passes. Or, use your benefits debit card to use pre-tax dollars on UberPOOL and Lyft Shared (formerly called Lyft Line) expenses tied to vanpooling in select cities.
• Parking. Save money when you park at or near your regular place of employment. You can also reserve or pre-pay for parking spots in select cities by adding your P&A debit card as a form of payment in the SpotHero app. Go to spothero.com/cities for a list of SpotHero-friendly cities.

What non-emergency conditions can an MDLIVE medical provider treat?

• • Acne
  • Allergies
  • Cold/flu
  • Constipation
  • Cough
  • Diarrhea
  • Ear problems
  • Insect bites
  • Nausea/vomiting
  • Pink eye
  • Rash
  • Respiratory problems
  • Sore throats
  • And more

What is the Employee Assistance Program (EAP)?

The Health Advocate EAP+Work/Life Program is brought to you to provide support with personal, family, and work issues to help you achieve a healthy work/life balance. Health Advocate provides one on one, 24/7 support. You have confidential access to a Licensed Professional Counselor for short-term counseling for any stressful issue any time you need it. Our other experts, including work/life specialists, legal and financial consultants, and other professionals, will help you get the information you need to get back on track. Call 866.799.2728 when you have a stressful concern and need help. You will then be assigned to a Licensed Professional Counselor who will provide dedicated support. Health Advocate can help you with almost any kind of personal problem, like:

• Stress, Anxiety, or Depression
• Relationship and Parenting Issues
• Anger, Grief, and Loss
• Substance Abuse issues
• Financial and legal concerns

How do I get my maintenance prescriptions set up through mail order?

Save on medications you take regularly (such as high blood pressure or diabetes medicine) when you have them delivered by mail, in 90-day supplies, from CVS Caremark Mail Service Pharmacy. It’s an easy way to make sure you have the medication you need, when you need it, with one less thing to worry about.

There are two easy ways to get started:

Online – Visit Caremark.com/mailservice

– OR –

By phone – Call the number on your member ID card for live help getting set up.  

Be sure to have a prescription bottle in hand, all the information needed to get started is on the label.

One 90-day supply typically costs less than three 30-day supplies, so you can be sure you’re paying a lower price. CVS Caremark delivers by mail, anywhere you choose, with no-cost shipping.

Mail delivery means no more monthly trips to the pharmacy, and with automatic refills, you won’t need to keep track of refill schedules either. CVS Caremark will alert you 10 days before a refill in case you need to change the delivery date or location.

Every order is filled by a licensed pharmacist, then quality checked before shipping. Our discreet packages are tamper-proof, weatherproof and temperature controlled. Plus, CVS Caremark will send status alerts by email, phone or text – so there’s nothing to worry about. Download the CVS Caremark mobile app to manage mail orders anytime, anywhere!

How can I estimate treatment costs?

Log into https://members.healthadvocate.com/.  Go to the Finance tab and select Health Cost Estimator+ from the drop down menu. Enter a procedure in the first field, your zip code in the next field, and the radius in which you’d like to see results.  Click on the Get Estimates button to get a list of estimates based on your search query.

What is telehealth?

Telehealth uses digital information and communication technologies to allow members to access healthcare away from the doctor’s office.  The Trust medical plan partners with MDLIVE to bring participants remote access to quality healthcare through MDLIVE’s board-certified doctors. They are professionally trained to use virtual technology to treat many non-emergency conditions. MDLIVE’s doctors are board-certified and have an average of 15 years of experience.  Go to https://members.mdlive.com/ect to register now!

I was billed by my provider for expenses I do not think I should have been billed for. Who should I contact for help with this?

Health Advocate’s experts will take on virtually any healthcare or administrative issue so you get to the right care at the right time at no cost to you.  If you’ve received a bill or have a claim that you need help with, call Health Advocate at 866.799.2728 or email answers@healthadvocate.com to have your own personal health advocate tackle the issue for you!  If authorizations are required to resolve your inquiry, the Advocate assigned to your case will send you any required authorizations forms electronically.

How do I read my medical EOB (Explanation of Benefits)?

Since an EOB isn’t a bill, what you pay is for your information only.  If you owe the doctor, or hospital, they’ll send you an invoice. Comparing the EOB and the invoice is a good way to make sure you’re getting billed correctly by the doctor or hospital.

Not all claims generate an EOB. For example, you won’t get an EOB for a prescription. EOBs show you the costs associated with the services you received, including:

• Claim Details, each service or procedure from each provider is explained
• What the provider charged
• What the allowed charges are (this is the contracted amount in which an in-network PPO provider agrees to accept as payment)
• Any non-allowed charges (discount or amount billed over the contracted amount for this service)
• What the Plan pays
• Total covered
• What you pay (summary of Deductibles, copays, and coinsurance)