Helpful Hints Using the MySource Debit Card for FSA/HRA

 When using the debit card, you must use the card at locations that are either coded as “health care” vendors by MasterCard or have implemented the Inventory Information Approval System (IIAS). The card will not work at a vendor without that health card vendor code or IIAS status. The vast majority of debit card transactions will not require claim submission and substantiation on your part as long as you go to either an IIAS approved vendor or any co-payment listed below for medical or Rx events you incur.

Your debit card will Auto-Substantiate Co-pays at the following locations:

EMPLOYER: Please Indicate Copays for (Company Name) Plan

Plan : ______Plan B: ______Plan C: ______

Rx-Name Band $______Rx-Name Band $______Rx-Name Band $______Rx-Generic $______Rx-Generic $______Rx-Generic $______Primary Care $______Primary Care $______Primary Care $______Specialist Care $______Specialist Care $______Specialist Care $______* $______$______$______$______$______$______$______$______$______$______$______$______*Please reference your Insurance plan design for additional Co-pay structures

You will always receive auto-generated system color-coded emails informing you what action, if any, needs to be taken each and every time you use your card. Those emails would be received as follows:

a. GREEN – Your transaction was resolved (via auto-substantiation, paper claim supporting the purchase or off-set from another claim reimbursement) and no action is necessary. b. YELLOW - Your transaction did not auto-substantiate and you will have 14 days from the date of purchase to submit the proper supporting documentation to substantiate the charge. c. ORANGE - Your transaction is still outstanding and you have 7 days remaining to submit the supporting documentation to substantiate this charge. d. RED - Your transaction is still unresolved and your debit card has been temporarily timed out. Once we receive the proper substantiation, or if this was for an ineligible item and the amount was paid back to your employer then the card becomes reactivated by the next day.