What to Expect at the Pharmacy

If your Employer provides you with the CareFlex Express Benefits Card, participants should use the card to settle all qualified medical expenses. The Benefits Card is only programmed to work at qualified medical terminals, transactions at non-medical providers will be denied. 

When making a purchase, the participant should always select “credit” when given the option.  The Benefits Card is considered an offline debit card with no PIN number and no access to ATM machines.

New regulations are in effect that require non-medical merchants like grocery stores, discount stores, pharmacies, and drug stores to adopt approval systems that determine at the point of sale the eligibility of an expense for reimbursement from a Flexible Spending Account, Health Reimbursement Arrangement, or Health Savings Account.

The majority of merchants that meet this classification have either adopted the IRS approved Inventory Information Approval System (IIAS) or the 90% Merchant Rule. 

If Pharmacy / Drug Store Merchant has Adopted IIAS:

1. Participant checks out, clerk scans all items.
2. Participant swipes CareFlex Express Benefits Card.
3. The Benefits Card covers the identified Health Care eligible items only.
4. Participants is responsible for using another form of payment for Non-Health Care items.
5. CareFlex will not request documentation, however participants should maintain receipt.

Current list of Merchants with the IIAS certification. 

If Pharmacy / Drug Store Merchant is certified under the 90% Rule (Effective July 1, 2009):

1. Participant checks out, clerk scans all items.
2. Participant swipes CareFlex Express Benefits Card.
3. The Benefits Card covers the identified Health Care eligible items only.
4. Transaction is authorized, and set as “Pending” in the CareFlex system
5. A notification is sent to the Participant (Email/ Letter) requesting documentation

Current list of Merchants with the 90% Rule certification. The 90% Merchant Rule allows for the convenience of payment using the CareFlex Express Benefits Card, but does not eliminate the documentation request process. 

Documentation Request Schedule:
First notice is sent as a 3 day reminder, second reminder 14 days after the original; third and final notice 14 days after the second notice is sent.

1. Participants are responsible for submitting a copy of an itemized receipt to CareFlex.
2. CareFlex reviews transaction and sets transaction to "Approved."
3. If documentation is not received within 31 days, the benefits card is set to "Temporarily Inactive" preventing further use.

Important Note:
Merchants must be identified in CareFlex’s Administrative System to allow benefits card transactions to be authorized. If the transaction is denied, the participant can either contact CareFlex to troubleshoot the problem or pay for the expense using another form of payment and then submit a manual request for reimbursement. 

To continue to accept benefit cards like the CareFlex Express Benefits Card, merchants must have adopted one of the two approval processes. Please note that depending upon your particular reimbursement program, certain expenses like over the counter drugs might not be covered under the plan limiting the use of the benefits card to merchants that process prescription expenses only.