When configured, transactions that match set copay amounts and merchant category codes will be approved and substantiated at the point of sale. That’s fewer receipts submitted for review. Here’s how you can set copay matching rules for your organization.
Set copay matching rules for your organization
Organization administrator feature
This feature is only available for organization administrators. Partner administrators can activate the copay matching feature and adjust the multiplier rule for the platform and an organization, but they cannot enter copay amounts for an organization.
Go to the Copay Matching tab.
Enter respective copay amounts for Medical, Dental, Vision, and Pharmacy categories.
If preferred for reporting, enter tags.
To save progress, select Save Changes.
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 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 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.
Example
A $20 copay and MCCs associated with doctor offices are acceptable for Bill’s FSA plan. So, if Bill swipes his FSA card for $20 at the pediatrician's office, his transaction will be approved and substantiated. He will not need to submit a receipt.
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 by applying its multiple to copay amounts. If a copay amount of $20 is entered and a multiplier rule of 3x is set, $20, $40, and $60 transactions will be approved and substantiated. You can find your organization's multiplier rule listed under the How It Works section.
Example
Bill visited the pediatrician's office with his two kids for their annual physicals. At the end of the visit, he owes the doctor $40 for two $20 copays. Since his administrator has set a multiplier rule of 4x and set a copay amount of $20, his transaction of $40 will be approved.
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 |
Contact benefit provider
Please contact your benefit provider to turn off copay matching, adjust the multiplier, and/or select MCCs.
Optional tags
Organization admins have the option to add optional tags to help organize copay amounts (like "urgent care” or “specialist visit”). These tags will help admins stay organized and may be used for future reporting.