participant certification language

[Guest kimb]

Harry Beker is saying the participant certification language should read, "expense has not been reimbursed and employee will not seek reimbursement". Is this to be interpreted as saying the employee does not have to submit the claim to their insurance company for payment first?

According to the EBIA Cafeteria Plan guidebook, Health FSA's are permitted to reimburse only medical expenses that are not rembursed or reimbursable through insurance or any other arrangement. We've had participants that have not wanted to submit psychiatric claims (for example) to their insurance company and try to be reimbursed for the full amount being charged for the visit. We told the participant to submit the claim to their insurance for payment first then we would recommend reimbursement on their out of pocket amount.

The new wording is not saying that the expense is not reimbursable under any other health plan coverage, but that the participant will not SEEK reimbursement under any other plan covering health benefits.

Any guidiance on this would be greatly appreciated. Thanks.

[GBurns]

While I cannot understand why any employee would want to use their own FSA money to pay the full bill rather than have the insurance company pay the majority of it, Isn't is the employee's right to make that determination?

[papogi]

Notice 2002-45 illustrates the IRS's interpretation of this issue (even though it actually addresses HRA's). It states, "A medical care expense may not be reimbursed from a 125 health FSA if the expense has been reimbursed or is reimbursable under any other accident or health plan." Harry Beker's statement certainly does not coincide with previous thought.