TN Strong Families Healthcare Reimbursement Account (HRA)
The TN Strong Families HealthCare Reimbursement Account (HRA) allows people to spend program dollars on IRS qualified HealthCare expenses. PayFlex is the TN Strong Families' HRA administrator. The HRA may be used with the PayFlex card to cover out-of-pocket medical expenses or to reimburse claims from an itemized receipt.
Referrals to TN Strong Families HRA must come from Tennessee Department of Children's Services. Children currently in state custody who have intellectual and developmental disabilities are eligible for this program.
The TN Strong Families Independent Support Coordinator (ISC) assists families with requesting the TN Strong Families HRA benefit. It is a one-time per year allocation and cannot be modified. We strongly encourage families to review the types of expenditures listed below while considering how much of their TN Strong Families funds to allocate to the HRA. DIDD cannot pay for claims submitted prior to the HRA authorization date on the plan. The $20,000 TN Strong Families budget expenditure cap may not exceed $20,000 across the calendar year and unspent funds cannot be rolled over into the next plan year. Once the services are authorized by the ISC on the child’s TN Strong Families support plan, PayFlex will mail your HRA debit card to the address on file.
Helpful tips on using the HRA may be found:
Families may expect to receive the HRA debit card within 21 days of authorization. If the card has not arrived within 21 days, please contact PayFlex at stateoftennessee@PayFlex.com. It will arrive in a plain white envelope in the foster parent’s name and contain instructions on how to set up the account. The date the HRA service is authorized on the child’s Person-Centered Support Plan (PCSP) is the first date expenses are eligible. For instance, if the HRA service is authorized on 8/1/23, a doctor’s visit that occurs on or after that date would be eligible for HRA use. A doctor’s visit that occurs on 7/28/23 would not be eligible.
Only the enrolled child is covered by the HRA. It is currently a one-time per year allocation and cannot be modified. Funds left over from one calendar year do NOT carry over into a new year. Families with 2023 expenditures have until 3/31/24 to submit claims.
You may log into the PayFlex online portal at www.PayFlex.com or download the PayFlex mobile app to review your HRA balance, submit claims and check claims status. Additional information regarding the PayFlex online portal are located at PayFlex Reimbursement Quick Reference Guide. For information on the Payflex mobile app, click PayFlex Mobile Application Flyer
Changes in Placement
- If there is a permanent disruption in the foster placement, the HRA Benefit follows the child to their new foster home. The ISC will work with the family to set up the new HRA account. The remaining balance of HRA funds will be made available and the date of eligibility remains unchanged.
The previous foster family will have 90 days to submit outstanding claims for reimbursement. The ISC will work with the previous foster family to identify unpaid reimbursements and work with PayFlex and the family to get claims submitted.
- Children in the Strong Families HRA will have one year of continued HRA eligibility after adoption. The ISC will continue to work with the family and connect them with other programs they may be eligible for after TN Strong Families eligibility ends.
The HRA can be used two ways:
- With the provided PayFlex card to pay for covered out-of-pocket medical expenses.
- Reimbursement claims with an itemized receipt.
Information about eligible expenses can be found in the appendix of this document. Those include but are not limited to:
- Copays and deductibles
- Speech Therapy, Occupational Therapy, Physical Therapy, and Non-Traditional Therapies
- Medical Equipment and Supplies
- Vision and Dental
- Respite (reimbursement only)
Using the PayFlex Card:
The PayFlex card can currently be used at medical offices such as hospitals, doctors’ offices, therapy offices, vision providers, dental offices, and pharmacies. When using the card, it’s important to run it as credit, not debit. Please be aware that credit/debit card processing fees are not a covered expense.
There is a daily spending limit of $2,650 on purchases made with the PayFlex card.
Receipts must be submitted to validate all card purchases, and some purchases require a Letter of Medical Necessity (LOMN) from a doctor to be an eligible expense. PayFlex currently aims to review and approve supporting documentation within 30 days.
Please be aware that the card cannot be used to purchase future appointments. For instance, the card cannot be used to purchase a block of 10 future therapy appointments, since there must be validation the visits have occurred. Doing so, may lead to suspension of your PayFlex card.
Submitting Claims for Reimbursement:
Reimbursement requests are typically processed by PayFlex within 7-10 business days but may take longer. These claims are paid by check or direct deposit.
You may submit HRA claims by logging into the PayFlex online portal at www.PayFlex.com or into the mobile app and selecting “File A Claim” to upload all supporting documentation (including receipts and invoices) for the expense. All claims should be submitted as expense type: “medical with deductible”.
The claim should include the following information:
- Provider or merchant name
- Type of expense (“medical with deductible”)
- Date of service
- Child’s name
- Child’s DOB
- Child’s last 4 digits of SSN
- Description of service
- EOB or other documentation showing reimbursement, or a statement that no other reimbursement is available and therefore no EOB to apply
- Final amount of patient liability owed (final out of pocket cost after all reimbursement)
- Letter of Medical Necessity (LOMN) if applicable
PayFlex will send an alert should the expense require additional information for upload. Be sure to respond timely to any requests as to not delay the determination. If no documentation is received within 56 days of the first written request, the PayFlex card will be temporarily inactivated until all appropriate supporting documentation of the expense is submitted and approved.
For information on how to file a claim, select Video: How to File a Claim with PayFlex.
For additional information on how to verify PayFlex card purchases, click How to Verify PayFlex Card Purchases Online.
To find helpful ways to submit claim documentation and prevent card suspension, please review Keep PayFlex Card Active Flyer.
PayFlex requires a Letter of Medical Necessity (LOMN) Form from the healthcare provider confirming the expenses are needed to treat a specific diagnosis. It must be completed by child’s physician or therapist, including - but not limited to - pediatrician, specialist, medical doctor, physician’s assistant, licensed/registered nurse practitioner, and occupational/physical/speech therapist. In addition, multiple expenses may be itemized on one form. If the form is not available, a statement on letterhead from the medical provider detailing each diagnosis and expense is acceptable. The letterhead should include the following information:
- Employer Name: State of Tennessee Strong Families HRA
- Member Number: last 4 digits of child’s social security number
To view the LOMN form, please click, PayFlex Letter of Medical Necessity Form
A Letter of Medical Necessity form does not need to be renewed on an annual basis IF a healthcare provider indicates on the form that it is effective for the child’s duration of enrollment in the TN Strong Families Program.
Once approved, reimbursement claims from itemized receipts are typically processed in 7-10 business days and paid by check or direct deposit.
If your HRA account has been frozen due to an overpayment of funds, you can remediate this by:
- Using another form of payment at the point of sale and submitting the claim to PayFlex
- Paying it back in full online in your PayFlex portal or by calling PayFlex at (855) 689-8943
- Making payments to PayFlex via check. The check will need to be made out to PayFlex and the address to send the funds to are:
PO BOX 8396
Omaha, NE 68103-8396
You must indicate you are part of the State of TN Strong Families HRA and the parent should indicate their full first and last name.
You may email PayFlex at stateoftennessee@PayFlex.com or call (855) 689-8943 if you have any questions. Be sure to indicate the child’s legal name and date of birth when contacting PayFlex. You may contact your Independent Support Coodinator with any questions.
- Tennessee Strong Families One Pager
- Tennessee Strong Families One Pager (Spanish)
- Tennessee Strong Families HRA Presentation
- Tennessee Strong Families Lunch and Learn
- Flow Chart - How Tennessee Strong Families HRA works alongside DCS Case Management
- TN Strong Families HRA PayFlex Presentation for ISCs
- Frequently Asked Questions