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ProBenefits, LLC has locations, listed below.

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    ComplaintsforProBenefits, LLC

    Insurance Services Office
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    Complaint Details

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    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      ProBenefits is a company that was hired by a private company to process and reimburse their employees who participated in the FSA program that was offered as part of the benefits program for 2021. ProBenefits is a third-party administrator and plan service provider of FSAs, and other programs. ProBenefits made it a policy to deny all claims for reimbursement causing great hardship on all plan participates. Denial was based on one of many reasons: claim the medical item for reimbursement was not covered, had insufficient documentation, documentation did not meet their requirements for IRS. ProBenefits made it impossible for working individuals to recoup the funds that had been submitted to the FSA plan they were to administer. It became apparent to the decision makers at ******** and ***** ********* that Probenefits was NOT acting in good faith nor in the best interest of the plan participants and cancelled the relationship with ProBenefits effective 1/1/2022. At this time Probenefits has in excess of $1700 of our money that was contributed in good faith to the FSA that they were to manage. We are asking for full reimbursement immediately plus reimbursement for any monetary damages that results because of their business practice.

      Business response

      02/02/2022

      As a third-party administrator (TPA) of Flexible Spending Accounts (FSAs), ProBenefits contracts with employers to ensure that their FSA plans are administered according to the relevant IRS guidelines. The reasons given in the complaint for claim denial (ineligible expense, insufficient documentation) are valid reasons that a claim might be denied for not meeting the standards set in the IRS guidelines. We are happy to work with participants to clarify the IRS rules and help them obtain the necessary documentation to resolve claims successfully. We apologize if the consumer did not find that to be the case during the time that ProBenefits was administering their plan.

      While some **** may do things differently, the ProBenefits business model requires that employers maintain their participants' withheld FSA contributions in an employer-owned bank account, which ProBenefits then drafts for employee FSA debit card charges or to reimburse claims. ProBenefits DOES NOT hold participant funds.

      In this particular case, the employer in question has chosen to move their FSA plan from ProBenefits to a different administrator effective January 1, 2022. The employer requested that ProBenefits not handle the runout for the 2021 plan year, meaning that after December 31, 2021, any further claims for dates of service during the 2021 plan year will need to be addressed by the new administrator. On January 10, 2022, ProBenefits sent a final account balance report for the 2021 plan year to the employer, for the purpose of informing the new plan administrator of remaining participant balances for 2021. The employer has confirmed receipt of this report. At this point the employer is responsible for conveying this information to the new plan administrator, who is then responsible for loading remaining 2021 balances in their system and for processing all participant claims going forward.

      In addition to submitting this complaint, the consumer also mailed us a complaint by certified letter. We have mailed a letter back to the consumer in response, and attached a copy of the response letter here.

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