Optum Financial’s
Payment Card Capabilities
Optum Financial’s payment card capabilities provide the most efficient and capable card processing platform in the marketplace. Our payment card technology complies with Inventory Information Approval Systems (IIAS) regulations which limit retail payment card transactions to qualified merchants.
We manage our own payment card without reliance on third-party assistance, allowing us to be nimble in adapting to new legislative and market changes.
Payment Card Benefits
A payment card from Optum Financial is the simplest way to purchase health care!
The payment card is offered as an enhancement to your benefits package. It provides a convenient way to access your account funds and pay for qualified medical expenses quickly and easily.
Rather than paying for qualified expenses with personal funds, then filing a claim and then waiting for reimbursement, using the card will allow you to access your funds directly and pay the provider. While you may still need to send receipts for substantiation purposes, you will not have to wait for your money to be reimbursed to you.
Optum Financial supports the administration of multi-purse accounts whereby any number of accounts can be logically set up in the system and placed on the same payment card, with funds being pulled from the accounts based on pre-set payment rules.
For those employers offering multiple accounts, Optum Financial sets the account stacking order of payment during the sponsor setup process.
The system has the flexibility to support a variety of stacking orders and can change the order for the accounts overall or for specific pre-defined categories of expenses.
How the Payment Card Works?
When participants use their payment card to access account funds, many of these transactions are automatically substantiated as qualified medical expenses without requiring the participant to submit supporting documentation.
Optum Financial is able to achieve best-in-class auto-substantiation rates for payment card transactions and automatically substantiates on the following types of transactions:
- Recurring claims
- Plan copays
- Purchases at supermarkets, grocery stores, department stores, and wholesale clubs that can identify account-eligible items at checkout (most large stores)
Payment Card FAQs
Health account funds are mandated by the IRS to be used for health care expenditures only, but there are literally thousands of products and services that meet the approved health care expenditures requirements in Section 213(d) Medical Expenses as defined in the IRS code. Depending on your account, these expenses may include deductibles, coinsurance, copays, prescription drugs, over-the-counter treatments, vision care. and dental care.
Refer to Qualified Medical Expenses to determine what is approved for your account(s).
Your payment card can be used nationwide at qualified health care providers (doctors, hospitals, etc.) that accept Visa. The card is programmed to work at merchant locations that are designated as health care merchants based on their Merchant Category Code (MCC).
And, depending on your plan, your payment card may also be accepted for qualified expenses at certain supermarkets, grocery stores, department stores, and wholesale clubs that comply with an IRS-required inventory control regulations, called IIAS (Inventory Information Approval System). IIAS compliant stores automatically check to ensure items purchased with a payment card are qualified health account expenses, reducing the need to submit receipts or worry about rejected claims.
The main benefit of the payment card is convenience. It allows you immediate access to your health account funds, as opposed to having to file a claim and wait for reimbursement. (As noted above, while you may still need to send receipts for substantiation purposes, you will not have to wait for your money to be reimbursed to you.)
An additional benefit is that some payment card purchases can be auto-substantiated without you needing to submit receipts. Examples of transactions that should not require receipts include:
- Copayments that match your employee’s group health insurance plan;
- Copayments that match your employer’s group pharmacy benefit;
- Recurring expenses of the same dollar amount and same location that have been previously substantiated;
- Purchases made at certain supermarkets, grocery stores, department stores and wholesale clubs that automatically provide substantiation through an inventory control system.
If a receipt is needed, you will be notified by email or letter. You can also review if your claim requires receipts by logging into your account online or on the mobile app. You need to submit receipts if you see a notice.
While the card can identify a health care location based on the Merchant Category Code, it cannot identify the items or services purchased. That is why in some instances, you will be required to send in documentation to verify that the card was used to pay for an eligible expense. Always save your receipts!
Depending on your account, if you use the card for an ineligible expense, you will be required to reimburse your account for that transaction or pay income taxes and an additional penalty tax.
The IRS has set up rules regarding when payment cards can be used. The payment card utilizes the merchant code of the provider to determine if the location typically sells or dispenses legitimate health care expenses. Valid locations include pharmacies, doctor’s offices and hospitals. If the card is not approved, then the provider is either not a qualified merchant or they have not properly set-up their merchant code.
Your card will also be denied if the amount requested from your card is more than your available balance. You can check your available balance online, on the mobile app, or by calling 877-906-7787. If your balance is less than the cost of the service or expense, you can ask the merchant to swipe the card for the available amount and then use another form of payment to pay the difference.
While most procedures performed in a doctor’s or dentist’s office are eligible expenses, some procedures are not. For instance, some doctors sell nutritional supplements and vitamins which are not eligible, and dentists perform teeth whitening, which is also not eligible. Therefore, the IRS requires that we receive documentation to identify the service performed is an eligible expense.
Yes. You can order an additional card through your online account. Or, contact Customer Service at 877-292-4040 to request a card.
No, the payment card is a stored value/restricted-use card that provides access to funds from your health account(s). It is provided to give you quick access to the funds in your account and should only be used at eligible locations for qualified plan expenses.
Provide your card to a qualified merchant or provider, and they will swipe your card like any other credit or debit card to pay for your purchase. If asked, select “credit,” to use it without a personal identification number (PIN), or “debit” to use a PIN. There is a preset PIN associated with your card, which is the last 4 digits of your card number. To select a different PIN, call 888-999-0121.
Funds for eligible expenses will be transferred directly to the provider or merchant from your health account. Please ask for an itemized receipt in case it is required for substantiation. An itemized receipt should include the date of service, name and address of the provider, the cost, and description of the service provided.
YES! Third-party documentation is required any time you use your payment card or request reimbursement except for the instances listed above. Therefore, always hold on to your receipt* in case further documentation is requested. The receipt must contain the following information:
- Name of patient (if applicable)
- Date of service
- Name and address of service provider/merchant
- Description of the service or expense provided
- Amount charged
*Please note that non-itemized cash register tapes, credit card receipts, and cancelled checks are not acceptable forms of documentation since they don’t include the required service details.
You must provide the receipts within the time requested or the transaction will be deemed ineligible, and you will be required to refund the amount of the transaction. If you fail to submit required receipts, your payment card will be suspended. If you fail to reimburse the account, the amount of the ineligible expense(s) may be withheld from your pay or added to your taxable wages. Make sure to keep your receipts in case IRS requires you to present them for verification during tax return.
Yes, depending on your plan. Due to the CARES Act passed on March 27, 2020, over-the-counter items are now eligible for tax-free purchase. That means these items no longer require a prescription or letter of medical necessity from a physician to be reimbursed pre-tax.
Just remember: even if you pay for these items with your card, you may have to submit an itemized receipt, so be sure to save all documentation.
What happens if I'm at a legitimate provider and my health care payment card doesn't work?
You should first check to see how the card was swiped. If your card is swiped as a “debit” transaction, you will need to provide a PIN. There is a preset PIN for your card, which is the last 4 digits of your card number. If you changed your PIN to a different number, be sure to use your updated PIN. Or, to use your card without a PIN, select “credit” at the payment terminal.
If the card still does not work, pay for the charge another way and contact Customer Service afterwards to determine the reason for the denial. You can go online or use the mobile app to request reimbursement for any eligible expenses in which the card was not used.
No, you still need to submit your expense through your regular claims procedure used by your health plan to determine what your share of the cost will be. If it’s not a simple copayment, you should wait for the claim to go through your insurance company and you receive your Explanation of Benefits (EOB) showing your financial responsibility. You should only charge the amount that your insurance company doesn’t cover.
No. If the current plan year has expired, you should file claims manually. A card transaction is processed with an assumed date of service equal to the date of the card swipe; therefore, it would pull money from the current plan year instead of the previous plan year. Keep this in mind if you receive services or have expenses towards the end of a plan year and are waiting for the EOB from your insurance company.
You should contact Customer Service immediately at 877-292-4040.
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