Navia Benefits Card/direct Deposit Authorization Form (Page 3 of 3) in pdf

Navia Benefits Card/direct Deposit Authorization Form Page 3

Direct Deposit

Navia Benefit Solutions will initiate all direct deposits on the same day as the check reimbursement date. Once

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your claim is approved, deposits may take up to two business days to appear in the designated account.

Navia Benefit Solutions will charge a $10 fee for returned items due to incorrect banking information you

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provide.

Navia Benefits Card

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You must provide a valid email address to receive the Navia Benefits Card.

Navia Benefit Solutions will send one card in the mail with your name on it. If you requested an additional card

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for a spouse or dependent, it will be sent separately. The first two cards are provided at no cost. There is a $5

fee for each additional card requested, or to replace lost or stolen cards.

You must elect the debit card each year you want to use the card. If you reenroll in the Medical FSA for 2017

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plan year, Navia Benefit Solutions will load your current card with your new FSA elections.

The debit card is valid for three years. Navia Benefit Solutions will send you a new card before it expires if you

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are enrolled at that time.

Ineligible Debit Card Expenses

You have up to 75 days from the transaction date to submit the necessary documentation requested. Per IRS

regulations, debit card transactions that have not been substantiated by the 75-day deadline will result in the

temporary suspension of your debit card. Your card will be reactivated once all outstanding transactions have been

substantiated.

Lost Receipts or Ineligible Expenses

You may use the following methods for correcting an ineligible debit card charge or lost receipts:

Pay back the amount of money you owe for the ineligible expense(s) you incurred by submitting a personal

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check, money order or payment to Navia Benefit Solutions or through online bill pay.

Submit additional eligible expenses as a substitute charge for the lost or unsubstantiated expense. You must

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note on the claim form or online when you substitute a claim for a previous ineligible card charge.

Navia Benefits Card/direct Deposit Authorization Form Page 3