frequently asked questions
These FAQs apply to Washington State Public Employees Benefits Board (PEBB) program benefits-eligible employees who work at state agencies, higher education institutions and community and technical colleges. If there is any conflict between information posted on the site and the FSA Enrollment Guide or DCAP Enrollment Guide, the Enrollment Guide prevails.
Your Medical FSA helps you pay for deductibles, copays, coinsurance, dental, vision, and many other expenses for you, your spouse or qualified tax dependent’s health care expenses, even if they are not enrolled in your PEBB medical or dental plan (See summary of eligible expenses on pages 4 and 5 of the Medical FSA Enrollment Guide).
You may also claim certain expenses for a child for whom you don’t get the tax exemption due to a divorce decree, as long as one parent claims the child as a tax dependent. The tax exemption may switch from year to year between parents. As long as one parent receives the tax exemption, the medical expenses you pay on behalf of the child to the provider may qualify for Medical FSA reimbursement.
Can I claim my child's eligible medical expenses through my Medical FSA even if I don't claim him or her as a tax dependent?
Yes, as long as he or she is:
- A “child” of the taxpayer (son, daughter, stepson, stepdaughter, adopted child or an eligible foster child (defined as an individual who is placed with the employee by an authorized placement agency, or by judgment, decree or other order of any court of competent jurisdiction); and
- Age 26 or younger for the entire plan year in which medical expenses are claimed. If you have a child who turns 27 in a plan year, his or her expenses cannot be claimed in that plan year.
The debit card is a feature that allows participants to use their Medical FSA funds directly, without paying out-of-pocket and waiting for reimbursement. However, the IRS has stringent regulations about where the debit card can be used and follow-up documentation is required for transactions that can’t be verified electronically. Using the debit card does not eliminate the need to submit follow-up documentation if requested by Navia Benefit Solutions. Navia Benefit Solutions will notify you at the beginning of each month of any transactions that require additional documentation.
You must provide documentation such as bills from your provider(s) or statements from your insurance company that clearly shows the following: provider name, date(s) of service, cost of service, and type of service(s) provided.
No, please do not send the originals. Copies of your provider statements or Explanation of Benefits (EOBs) will suffice.
No, we do not require proof of payment in order to process your Medical FSA claim. Your documentation must clearly show that the services were incurred. Please note that for orthodontia expenses, the date of payment is considered the date that services are incurred.
Internal Revenue Code regulations require reimbursement claims state the type of services provided. The regulations also require the plan administrator to determine whether the expense qualifies under the plan and whether the services were provided during the period that the participant was covered under the plan.
Yes, you may submit your claims through your online account access at http://pebb.naviabenefits.com or through the MyNavia mobile application. To download the mobile application, search under “Navia Benefit Solutions” in the App store or Google Marketplace.
Claims are processed each business day, excluding major holidays. Claims will be reimbursed, up to the lesser of the claim amount or the FSA available account balance. Please refer to your Medical FSA Enrollment Guide for additional details.
Once your claim is approved, your reimbursement will appear in your bank account within two business days after the reimbursement date. If your claim requires additional substantiation, it will take longer to be reimbursed.
Generally, yes, as long as they are prescribed by a physician and are legal under federal and state laws. However, prescriptions that are purchased solely for cosmetic purposes that don’t treat an existing medical condition do not qualify. Additionally, federal law doesn’t allow reimbursement for drugs purchased in foreign countries, even if they are prescription drugs. The only exception to this rule is if you are in a foreign country and purchase and consume the drug while you are in the foreign country.
Each prescription does not have to be listed on a separate line of the claim form. You can group prescriptions from the same pharmacy on one line of the claim form, indicating the range of fill dates and total cost.
You may file claims as soon as you incur charges (have services provided) after the plan year has begun.
Incurred is defined in Internal Revenue Code Section 125 as the date the services are provided that gave rise to the expense. Expenses are not considered provided at the time you are billed for or pay for services.
Substantiation is the requirement by the IRS to verify expenses for eligibility before being paid or reimbursed.
You can file claims at any time during the plan year.
The deadline for submitting claims to Navia Benefit Solutions is March 31 following the end of the plan year. Please refer to the Medical FSA Enrollment Guide for specifics.
If your employment ends mid-year, you are eligible for reimbursement of expenses incurred on or prior to your date of termination. You must submit all claims for incurred services by March 31 following the end of the plan year. The DCAP benefit is not eligible for continuation under COBRA.
As of January 1, 2011, many over-the-counter (OTC) medicines or drugs require a prescription for reimbursement. If the OTC medicine or drug contains an active ingredient, then you must have a doctor’s prescription in order to be reimbursed for the expense. You can also ask the doctor to complete the Letter of Medical Necessity.
Generally, no. However, if you have been diagnosed with a medical condition and your doctor has prescribed these items then they may qualify for reimbursement. Your claim must include a letter of necessity or prescription (if the expense contains an active ingredient). This letter or prescription is valid for 12 months from the issue date. A sample letter of medical necessity is available on the Forms & Documents page of the Navia Benefit Solutions website.
Transportation that is primarily for and essential to obtaining medical care, including:
- Bus, taxi, train or plane fares or ambulance services;
- Transportation expenses of a parent who must travel with a child who needs medical care;
- Transportation expenses of a nurse or other person who can give injections, medications and other treatment required by a patient who is traveling to receive medical care and cannot travel alone; or
- Transportation expenses for regular visits to see a mentally ill dependent, if these visits are recommended as part of treatment.
Mileage is reimbursable for use of a car for medical reasons. You can also include parking fees and tolls. You can add these fees and tolls to your expenses whether claiming actual car expenses or using the standard mileage rate.
List the total miles traveled to obtain medical care on a separate line of the claim form. Multiply the total miles traveled by the standard mileage rate provided by the IRS and enter that total into the claim form. If you do not include the total miles traveled to obtain medical care your request for mileage reimbursement will be denied.
Your authorization for direct deposit remains in effect with Navia Benefit Solutions until you change or revoke that authorization. We retain direct deposit information from plan year to plan year.
You can log in to your account and update your direct deposit information or complete a direct deposit form and return it to Navia Benefit Solutions.
Does my employer notify Navia Benefit Solutions when I change my bank account number for direct deposit for payroll?
No. You are responsible to notify Navia Benefit Solutions if your direct deposit information changes.
If you have provided an email address, you will receive an email notification once your claim has been processed. You can view all claims processed by Navia Benefit Solutions by logging into your online account or through the mobile application. To view your account online, go to http://pebb.naviabenefits.com and click on the link “log in.” Follow the prompts to determine if you must register your account first. Please make sure to let Navia Benefits Solutions know if your email address changes to continue receiving email notification.
You may view your balance and account activity on the Navia Benefit Solutions website by going to Account Login. In order to access your account, you will need to create a log in and password. You can also access your balance through the mobile application or by calling Navia Benefit Solutions customer service at 1-800-669-3539.
The list of Eligible Expenses is a general overview. If you have questions after reviewing the list, contact Navia Benefit Solutions at 1-800-669-3539.
You may change your election if you have a special open enrollment event (qualifying event in status). Refer to the Medical FSA Enrollment Guide for details.
The annual minimum contribution is $240 and the maximum is $2,500.
If you have not spent all the funds in your Medical FSA by December 31, you may continue to incur eligible health care expenses through the grace period. The Medical FSA grace period ends March 15 of the following plan year. You must submit all claims for your Medical FSA to Navia Benefit Solutions for reimbursement by March 31 of the following plan year. Money left in your account after that date cannot be refunded and will be forfeited to the plan administrator, the Health Care Authority. This is referred to as the “use-it or lose-it” rule.
Note: If you reenroll in a Medical FSA for the following plan year, any claims incurred during the grace period (January 1 – March 15 of the following plan year) will be applied first to unused funds from the prior plan year first.
DCAP expenses eligible for reimbursement include:
- Day care for your qualifying child 12 years old or younger who lives with you and for whom you provide more than half of the qualifying child’s support.
- Day care expenses for your spouse, qualifying child, or qualifying relative who is physically or mentally unable to care for himself, resides with you and has income less than the federal exemption amount.
See the DCAP Enrollment Guide for additional information.
Your child must live with you for more than half of the year in order to be eligible for reimbursements through the DCAP. The parent who has more than 50% custody is eligible for the dependent care regardless of which parent claims the tax exemption.
No. Your day care provider can be a private individual or a licensed day care provider. The provider must provide you with their Social Security Number or federal Tax ID number. Additionally, the provider cannot be:
- A parent of the child.
- A dependent on your tax return for you (or your spouse if filing jointly).
- A person under age 19 at the end of the year, even if he or she was not your dependent.
You must provide documentation from your provider to Navia Benefit Solutions that clearly shows the following:
- Care provider name
- Name of the person for whom services were provided.
- Date(s) of service
- Cost of service
- Description of the service(s) provided
Your provider may also sign the day care claim form instead of providing separate documentation. No further documentation would be required then. Employees also have the option to sign up for recurring day care claims, through their profile on the participant portal.
No, you do not need to provide proof of payment.
You may fill out a day care services recurring claim form instead of submitting a day care claim. A claim is automatically processed according to the interval you designate for your day care costs.
You may submit the required documentation (such as copies of your receipts) using one of the following methods:
- Online: http://pebb.naviabenefits.com
- Fax: 425-451-7002 or toll-free 1-866-535-9227
- Email: email@example.com
- Mail forms and documentation to: Navia Benefit Solutions, PO Box 53250 Bellevue, WA 98015-3250
- Mobile App: You can submit a claim through MyNavia, available on both Google Play and the App Store. You can find the app by searching MyNavia or Navia Benefit Solutions.
Yes, you may submit your claims through your account at http://pebb.naviabenefits.com or through the MyNavia mobile application. To download the mobile application, search under “Navia Benefit Solutions” in the App store or Google Marketplace.
Claims are processed each business day, excluding major holidays. Claims will be reimbursed up to the DCAP available account balance. Please refer to your DCAP Enrollment Guide for additional details.
Once your claim is approved, your day care reimbursement will appear in your bank account within two business days after the reimbursement date. If your claim requires additional substantiation, it will take longer to be reimbursed.
You may file claims as soon as you incur charges (have services provided) after the plan year has begun. However, remember that DCAP works like a bank account. Reimbursement cannot exceed the account balance and you cannot receive reimbursement until after the service has been provided.
You can file claims at any time during the plan year. Keep in mind that all your claims must be filed by March 31 following the plan year.
No, Navia does not have a minimum claim amount. However, DCAP works like a bank account. Reimbursement cannot exceed your DCAP account balance.
Incurred is defined in Internal Revenue Code Section 125 as the date the services were provided that gave rise to the expense. Expenses are not considered provided at the time you are billed for or pay for the services. For the DCAP, this means if you pay for your services in advance, you cannot claim these expenses until they have all been provided.
For example, if you pay for February’s day care expenses at the beginning of February, you cannot be reimbursed for all of February’s expenses until the end of February. You may, however, submit claims each week at the end of that week for the services already provided.
Your authorization for direct deposit remains in effect with Navia until you change or revoke that authorization. Navia keeps direct deposit information from plan year to plan year.
You can log in to your online account and update your direct deposit information or complete a direct deposit form and return it to Navia.
No. You are responsible to notify Navia Benefit Solutions of any changes to your direct deposit information.
If you have provided an email address, you will receive an email notification once your claim has been processed. You can view all claims processed by Navia by logging into your online account or through the mobile application. To view your account online, go to http://pebb.naviabenefits.com and click on “log in”. Follow the prompts to determine if you must register your account first.
You may view your balance and account activity on the Navia web site by going to Account Login. In order to access your account, you will need to create a login and password. You can also access your balance through the mobile application or by calling customer service.
No, expenses for kindergarten tuition are considered educational in nature and are not eligible for reimbursement under the DCAP.
You may change your election if you have a special open enrollment event (qualifying event). Refer to the DCAP Enrollment Guide for details.
Expenses for care cannot include your costs for food, clothing, or entertainment. However, if these amounts cannot be separated from the cost of caring for the qualifying person(s), you can include the total cost.
If I can obtain day care documentation in advance of the services, can I file my claim at that time?
Yes, you may submit your claim for services for the upcoming month at the beginning of the month.
No, the Internal Revenue Code doesn’t allow expenses for overnight care. The charges cannot be prorated to include the portion that was for care during the day while you were working.
Generally, no. However, if the primary purpose of these camps is for care and well-being in order for you (or you and your spouse if married) to be gainfully employed, they may qualify. If the purpose of the camp is for care and well-being, you must send a statement with each claim submitted, stating that the child attends that camp primarily for care and well-being and not for educational purposes. Overnight camps are not eligible for reimbursement.