Forma may request additional information, such as an Explanation of Benefits (EOB) or a Letter of Medical Necessity (LMN), when required to verify that a product or service is eligible for reimbursement when you submit a pre-tax claim.
Explanation of Benefits (EOB)
All Health FSA and HRA claims must include proof from an independent third-party to verify that the expense qualifies as a medical expense under the law and plan guidelines. An Explanation of Benefits (EOB) is one type of acceptable documentation, though an itemized statement from the provider or other documentation can also fulfill this requirement. The documentation must include:
- Name of the expense
- Date of the expense
- Amount of the expense
- Name of the person who incurred the expense
This information is required for all claims, except for card transactions that automatically adjudicate. Credit card receipts and similar documentation is generally not sufficient because it does not include all elements required for substantiation.
In certain situations, you must submit an Explanation of Benefits (EOB) for reimbursement. This typically applies to post-deductible HRA enrollees also contributing to an HSA. To maintain HSA eligibility, HRA coverage cannot begin until you’ve met the minimum HSA deductible. The EOB serves as proof that the deductible has been met, allowing the post-deductible HRA to reimburse expenses.You will be asked to provide an EOB in these cases. Insurance companies provide EOBs anytime you incur a medical expense covered under the group health plan. They are generally sent in the mail and also available in your online medical insurance portal.
Letter of Medical Necessity (LMN)
Certain Health FSA and HRA expenses, called "dual-purpose" expenses, may serve both medical and personal purposes depending on the reason for the purchase. Examples include supplements, gym memberships, or cosmetic procedures. To qualify for reimbursement, these expenses require both standard documentation and a Letter of Medical Necessity (LMN).
The LMN must come from a healthcare provider and confirm that the expense is recommended to treat a specific medical condition. For example, a gym membership recommended by a provider to treat an obesity diagnosis would require an LMN. Even card transactions that auto-adjudicate may require an LMN for dual-purpose expenses.
If an LMN is necessary, you can submit Forma’s LMN Template to your healthcare provider for completion. Upload the completed letter as a receipt attachment when submitting your claim.