Manage copay matching settings for the platform
Learn how partner admins can enable organization admins to set copay matching rules for their organization.
You can use our platform technology to facilitate copay matching. When enabled, card transactions that match set copay amounts and set merchant category codes will be automatically approved and substantiated.
How to manage copay matching settings for all organizations on the platform
Partner Administrator Feature
This feature is only available for partner administrators. Organization administrators can enter copay amounts for their organization, but they cannot activate copay matching or adjust the multiplier rule.
Go to Settings.
Under Copay Matching, activate the copay matching toggle for organizations.
If desired, adjust the multiplier rule.
Choose where to apply updates
New Organizations: Apply updates as default settings to future organizations
New and Existing Organizations: Apply updates to all organizations (replaces any existing custom settings)
Applicable benefits
The Internal Revenue Service (IRS) allows for copay matching rules to be set for the following benefit plans:
Dependent care flexible spending accounts (DC-FSAs)
Flexible spending accounts (FSAs)
Health reimbursement arrangements (HRAs)
Limited-purpose flexible spending accounts (LP-FSAs)
Substantiation requirements
Substantiate
To provide evidence to support or prove the truth of
The Internal Revenue Service requires substantiation for DC-FSA, FSA, HRA, and LP-FSA reimbursement. That means benefit program members must provide evidence (i.e., a receipt) for their expenses, and administrators must review the submitted evidence.
The IRS permits administrators to set rules so that copay transactions are auto-substantiated. An auto-substantiated FSA or HRA transaction is automatically approved (card swipe goes through), and the member does not need to submit a receipt or bill for administrator review.
Copay matching rules
Card transactions matching both copay amounts and merchant category codes will be automatically approved and substantiated. Copay (or copayment) is a fixed dollar amount that health plan members pay out-of-pocket for covered healthcare services at the time of care. A merchant category code (MCC) is a four-digit code assigned to businesses based on the type of goods and services they provide.
So, if Bill swipes his FSA card for his plan’s $50 copay at an MCC associated with pediatrician offices, this transaction could be auto-substantiated if the copay matching rules are set up correctly.
Copay amounts
Organization admins can enter copay amounts under the Copay Matching tab for their organization. To learn more, check out “Set copay matching rules for your organization.”
Merchant categories
On our platform, benefit plans offered with a card come with a pre-set selection of appropriate merchant categories for the benefit. To learn more about how partner admins can edit merchant categories, check out “Control card spend with Merchant Categories."
Multiplier rule
The multiplier rule is designed to recognize when an individual pays for multiple copays in one transaction. Someone may be picking up multiple prescriptions for their family or may be paying for back-to-back appointments for their two kids.
Example
If a $20 copay amount is entered and a multiplier rule of 3x is set, transactions of $20, $40, and $60 for approved merchant category codes will be approved and substantiated.
Who sets copay matching rules
Organization admins enter copay amounts in their organization settings, and partner admins set merchant category codes in the benefit plan’s settings. The multiplier rule is set by partner admins under their platform settings.
Criteria | Definition | Example | Owner | Location |
Copay amount | the fixed dollar amount health plan members pay out-of-pocket for covered services | $20 | organization administrators | Copay Matching tab under the applicable organization |
Merchant category code | a four-digit code assigned to businesses based on the type of goods and services they provide | 8062 - Hospitals | partner administrators | Card Details under benefit plan settings |
Multiplier rule | the number of copay amount multiples accepted | Multiplier rule of 3x with $20 copay = $20, $40, & $60 amounts accepted | partner administrators | Settings for partner administrators |
Applying updates
All confirmed updates are applied as default settings to any organizations created in the future. To apply new updates to organizations that already exist, choose New and Existing organizations.
Warning
Applying updates to new and existing organizations will wipe out any existing custom settings for existing organizations.
Custom organization copay matching settings
Partner administrators can also customize copay matching settings for one organization. This includes:
Activate or deactivate copay matching for that organization
Adjust the multiplier rule for that organization
Organization administrators make e
To customize copay matching settings for an organization:
Go to Organizations tab in the side menu
Choose the desired organization
Select Organization Settings
Make desired adjustments under Copay Matching
Save any updates made