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Privacy Notice Regarding Protected Health Information This Notice describes how BAI, collectively we, us, or our, may use and disclose Protected Health Information to carry out payment and health care operations, and for other purposes that are permitted or required by law. Please see click the link below to be directed to BAI's privacy notice regarding protected health information. Certification of Medical Necessity Effective January 1, 2010, FSA participants must use this form to be reimbursed for over-the-counter medicines and drugs. As of January 1, 2010, these expenses cannot be reimbursed from an FSA unless they were incurred out of medical necessity. This form can be used to request reimbursement from your FSA for expenses that typically do not qualify for reimbursement from an FSA if the expense is tied to medical necessity. HIPAA Authorization Form (Use & Disclosure of Protected Health Information) Complete and submit this form if you wish to allow any person other than yourself permission to contact our Service Center about your benefits. Our specialists cannot disclose information about you to any individual(s) other than yourself if an authorization form is not on file. FSA Calculator The FSA Calculator will help you determine an appropriate Annual Health Care FSA Contribution Amount. And, it will automatically calculate estimated tax savings based on your Annual FSA Contributions. IIAS Merchant List This list identifies merchants using an Inventory Information Approval System (IIAS) capable of identifying FSA/HRA-eligible expenses at the point of service. When you use the Benny Prepaid Benefits Card to pay for qualifying expenses at these merchants, you will not be requested to submit receipts to validate your expense! Health Expenses Dependent Care
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