While being SIGIS IIAS Certified enables a merchant to be in compliance with IRS guidelines in accepting FSA and HRA cards, SIGIS IIAS Certification does not guarantee 100% acceptance of cards.
SIGIS Member issuer/processors and the majority of their clients who provide employee FSA and HRA cards have enabled SIGIS IIAS processing to authorize and auto-substantiate transactions.
However some employer benefit plans may require a level of transaction detail that is not supported by the SIGIS IIAS Standard, thereby, preventing acceptance even at merchants with a fully SIGIS certified IIAS solution.
Merchants that have implemented IIAS systems may continue to see declines on health care benefit cards that are standard payment card declines (insufficient funds, closed account, etc.). Thus, if the card transaction declines, it is most likely that the decline is valid.
Listed below are the main reasons why properly formatted IIAS transactions at an IIAS merchant may be validly declined. Note: The list below is not intended to be all-inclusive, but, represents the most common reasons that together account for most declines.
MOST FREQUENT VALID DECLINE REASONS
- The card has not been activated or has been suspended.
- The card has no funds remaining, or the card has insufficient funds and the merchant does not support partial authorization.
- The cardholder is attempting to purchase only non-health care eligible items with a card that has only an FSA and/or HRA purse.
- The participant's plan only reimburses the prescription drug amount and (a) The merchant does not send the Rx amount in the auth message, or (b) The plan requires a match to claim(s) from a pharmacy benefit manager (the cardholder's prescription drug plan) and the transaction failed to match, or (c) The merchant sends the Rx Amount but does not support partial authorizations and there are non-Rx items being purchased.
- The participant's card has not been loaded with funds for the new plan year because of delays by the employer or TPA in getting the enrollment file to the issuer processor.
- The merchant sent an expiration date that does not match the date in the issuer processor's system - this can happen when there is an error key entering the expiration date.
- The merchant manually keys in a card number that does not match a valid card on file with the issuer.
- The cardholder was issued a new card, either because his/her employer changed TPAs or she/he changed employers, but is continuing to use the old card that has been closed.
- The participant tried to use their card as a PIN debit and they entered an incorrect PIN number.
- The participant tried to use their card as a PIN debit and the merchant does not support PIN debit FSA transactions.