Payments and Claims
Please call the provider first to give them your insurance information. If you continue to receive a bill, please contact Member Services.
New York State requires us to send out invoices, regardless of being set up with automatic payments. You will continue to receive these invoices
Members can log into their online portal account, and find the information under the Claims and Spending Tab. From there you can view your claims, print/view Explanation of Benefits, and print a Claims History.
To elect for paperless delivery, please log into your member portal account and follow the below steps:
- Navigate to Profile
- Select Contact Info
- Verify Your Email Address
- Select Preferences
- Elect for Paperless Delivery
All FSA and HSA’s eligible expenses are determined by the IRS. You can utilize resources like Nova’s eligibility tool or resources such as the FSA Store or the HSA store. These resources will tell you if the item/service itself is eligible however there are additional pieces of information you should know prior to using funds.
Items should be purchased (or services should be rendered) while your plan is active. Your plan may have some nuances like a Run Out or a Grace period. Please contact your administrator to inquire if your account has either option.
Any services rendered for a spouse/dependent should be listed on the account in order to qualify as an eligible expense. You can inquire with your employer if a spouse/dependent can be added onto the account.
A Run Out Period is an extension past the last day of the plan year to give FSA participants more time to file for reimbursement of claims incurred during the plan year.
Example: If your plan year went from 1/1/2021- 12/31/2021 but you have a run out that ends on 3/1/2022. You have until 3/1/2022 to use up funds by submitting for reimbursement for any expenses that incurred while the plan was active which in this case is 1/1/2021-12/31/2021. This also means you cannot use the funds in your current active plan to pay for services rendered in the previous plan year. If you have a Visa card, do not use the card in this scenario, pay out of pocket and submit for reimbursement.
A Grace Period is an extended period of coverage at the end of every plan year that allows you extra time to incur expenses to use your remaining FSA balance after the plan year closes.
Example: If your plan year went from 1/1/2021- 12/31/2021 but you have a run out that ends 3/14/2022. You can the funds in the plan year that ended 12/31/2021 for expenses that have incurred during that plan year AND during 1/1/2022-3/15/2022.
Yes. You can request to be reimbursed for an eligible expense if you paid out of pocket, however, you will need to include an FSA Claim Form. If you are requesting for reimbursement via the portal or mobile app, the claim form is not required.
It is dependent on what is being submitted. Technically, all services that can be billed to your insurance carrier should be billed to your insurance carrier. Because of this, it is best to submit either your Explanation of Benefits or a claims history report. Both can be obtained by your insurance carrier.
For prescription requests you should submit an Explanation of Benefits, a claims history report from your insurance carrier or an RX tag. For services that would not be billed to your insurance, like cough syrup, you need your receipt.
No. Nova has an DCA Claim Form that can be signed by the location/person rendering the DCA related services. If that form is completely filled out and signed by the location/person rendering the service, the receipt is not required.
You can download the NovaFlex app in your app store.
Yes. If you would like your listed spouse/dependent, or any other representative, to have access to your reimbursement account, including but not limited to your balance, you will have to fill out a HIPAA form.
No, you do not need to activate or create a PIN for your Health Extras Card. The card is automatically activated once the plan is effective.
Member ID Cards
Typical turn-around-times for member identification cards are 7-10 business days.
Pharmacy and Prescriptions
Your plans list of covered medications, or formulary, is available online under Formularies and Pharmacy. Please select your plan type to review the list.
You may do so by logging into your member portal account and clicking “launch” on the Nations OTC box. This will automatically log you into the Nations website. From there you can add any desired items to your account and complete the checkout process. You can also call directly Nations at 877-270-4239.
Members should contact their source of enrollment for eligibility and termination inquiries.
You can allow a friend or family member to call on your behalf by filling out the Protected Health Information/HIPAA Authorization Form. The completed form can be returned via mail to the address listed or sent via email to firstname.lastname@example.org.
- Your primary care provider is not accepting new patients. In this case, if you already are a patient, please contact member services and we will have them listed.
- There are certain plans that require a Primary Care Provider to belong to a specific provider group. (ThRed Membership, requires members to list a GPPC (General Physician, PC as their PCP of record)
- Your primary care provider is not listed as a PCP
- Your primary care provider does not accept your plan