Account basics

What is a Healthcare Flexible Spending Account or Healthcare FSA?

A Healthcare FSA is a valuable employee benefit that allows you to have pre-tax dollars withheld from your paycheck to pay for un-reimbursed healthcare expenses. It covers not just your medical expenses, but also the expenses of your spouse and tax dependents.

Even with the best health plan, you are likely to have out-of-pocket expenses each year.

A Healthcare FSA can cover medical, dental or vision expenses that you would otherwise pay for out-of-pocket. Qualified expenses typically covered by a Healthcare FSA will include deductibles, coinsurance or copayment amounts for your health plan, eye glasses or contact lenses, dental work and orthodontia, medical equipment, hearing aids and chiropractic care.

Many over the counter items are eligible for reimbursement from a Healthcare FSA:

  1. Eligible - Insulin and health items that do not contain any medicine or drugs (bandages, contact lens solution, hearing aid batteries, diagnostic and testing products, reading glasses, etc.) are eligible and do not require a prescription, letter of medical necessity or doctor's directive.
  2. Eligible with Prescription - Over-the-counter items that contain a drug or medication (cold and allergy medicine, pain relievers, sleep aids, etc.).
  3. Eligible with Letter of Medical Necessity or Doctor's Directive - Dual Purpose items can be used for a medical reason or for general health purposes and require a prescription, letter of medical necessity or doctor's directive. These items include products such as dietary, fiber and weight loss supplements, vitamins, orthopedic shoes and inserts, and snoring cessation aids.

Your employer may limit the expenses your plan reimburses; please contact your Human Resources office for more information. For a list of IRS eligible expenses please, see Qualified Medical Expenses.

What are the benefits of a Healthcare FSA?

Your biggest advantage is the tax savings. Every dollar you set aside in your account reduces the amount you pay in income taxes. Plus, you can be reimbursed for qualified expenses that you are already paying for with after-tax dollars!

How does a Healthcare FSA work?

  1. Funding. You typically contribute a pre-determined amount to your account. In some cases, your employer may also contribute to employee FSAs. (Please contact your Human Resources office for a copy of your employer’s contribution schedule.)
  2. Accessing Funds. When you have an eligible healthcare expense, pay for them with your healthcare payment card, or pay out-of-pocket and request reimbursement online. Remember to always keep your receipts.
  3. Requesting Reimbursement/Substantiating Purchases. Log on to your online account and visit the Claim Center.
    If your payment was out of pocket, you will click "Make a Payment / Add a Claim" and follow the instructions to enter the required information. Then print out your Claim Form and use it as a fax cover sheet to send it and your receipts to the number shown on the form.
    If the purchase was made using a healthcare payment card, you will skip the "Make a Payment / Add a Claim" process and simply print out the Claim Form for that card purchase. Use the Claim Form as a fax cover sheet and send it and your receipts to the number shown on the form.
  4. Please remember that credit card receipts, non-itemized cash register receipts and cancelled checks cannot be used to substantiate a claim.
  5. Claims Processing. We will process your request and reimburse you according to your elected payment method. Please note that you will receive your money sooner if you use direct deposit.
  6. Account Management. Log in to your online account regularly to check your account balance and access health education tools.

Is a Healthcare Flexible Spending Account (FSA) the same as a Health Reimbursement Arrangement (HRA)?

No. One of the main differences between the FSA and the HRA is the source of funding. HRAs are funded solely through employer contributions while FSAs are typically funded by the employee, usually through pre-tax, payroll deductions. Contact your Human Resources office for the specifics of your plan.

Eligible expenses

What types of expenses are eligible for reimbursement with a Healthcare FSA?

The rules for funding and accessing funds in a Healthcare FSA are legislated by the IRS and mandated to be used for healthcare expenditures only, but there are literally thousands of products and services that meet the approved healthcare expenditure requirements for Medical Expenses as defined in Section 213(d) of the IRS code.

Qualified medical expenses are defined as: copayments or coinsurance, dental care costs, vision care costs, prescription medications and some over-the-counter medications. Your employer may limit the expenses your plan reimburses; please contact your Human Resources office for more information. For a general list of approved healthcare expenditures, please refer to the list of Qualified Medical Expenses.

What types of expenses are not eligible for reimbursement with a Healthcare FSA?

Services that are typically not eligible or reimbursable from a Healthcare FSA include:

  • Skin or teeth bleaching/whitening;
  • Health club dues;
  • Hair transplants;
  • Electrolysis;
  • Cosmetic surgery or treatments of any kind; and,
  • Contract fees for maintenance/replacement of contact lenses or eyeglasses.

Please refer to the Qualified Medical Expenses list to find a general list of non-eligible expenses.

What happens if I use the account for a non-eligible expense?

If you file a manual request for reimbursement of a non-eligible expense, the request will be denied. If you used the healthcare payment card and the expense is deemed ineligible after the expense is already paid, you will be required to reimburse your account for that transaction. If you fail to reimburse the account, you may be required to pay income taxes.

Contributions and tax information

How much can I contribute to my Healthcare FSA?

Beginning January 1, 2013, Healthcare FSA contributions are limited by the IRS to $2,500 each year. The limit is per person; i.e., a husband may contribute up to $2,500 to his employer’s Healthcare FSA and a wife may each contribute up to $2,500 to her employer's Healthcare FSA. Employers may elect a lower limit as part of their Healthcare FSA plan design. You should check with your Human Resources office for the specifics of your plan. The IRS contribution limit will be adjusted annually to account for inflation increases.

Can I transfer money from my Dependent Care FSA to my Healthcare FSA (or vice versa)?

No, this is not allowed.

What happens if I do not claim all the money in my account?

The IRS regulates Flexible Spending Accounts under IRS Code Section 125. According to the IRS guidelines, funds that are not claimed during the plan year must be forfeited. This is called the "use it or lose it" rule. Funds are not transferable from one plan year to another and they are not available for other benefits. Your employer may offer a grace period. You should check with your Human Resources office for the specifics of your plan. The unused funds are retained by the plan sponsor, your employer, and may be used to offset administrative costs of the plan

What information is reported to the IRS?

No information related to an individual Healthcare FSA is reported to the IRS. Your employer, may be required to file an IRS form 5500 which includes FSA participation and total disbursement information for the plan (Form 5500 does not include individual FSA information).

Health insurance coverage

What if I am not covered under my company's health plan?

Unless your employer requires participation in the company's health plan as an eligibility requirement for the healthcare FSA, you and your family can still participate in the Healthcare Flexible Spending Account even if you are not covered by the company's health plan.

Can I enroll in a Healthcare FSA to reimburse my spouse's deductible and copayment expenses?

Yes. All eligible out-of-pocket expenses incurred by you, your spouse and your qualified dependents can be reimbursed from your Healthcare FSA, even if your spouse and qualified dependents are not enrolled in your employer’s health plan.

Using your account

How will I be able to access my Healthcare FSA funds?

You can pay for eligible expenses with any form of payment and request reimbursement from your account.

How can I find out my account balance and review transactions?

Account Balance and Claims Status information is available by:

  • Logging on to your online account at any time for balance information. Your online account is secure and updated in real time.
  • Calling the BenefitWallet IVR at any time for automated account balance information.
  • Contacting the BenefitWallet Service Center.

Can I make changes to my election amount?

Once an election for the FSA(s) has been made, you cannot change the amount unless you terminate employment with your company or there is an appropriate change in status. Valid changes in status for both Healthcare include:

  • Legal marital status change - marriage, divorce, death of spouse, legal separation or annulment
  • Change in number of dependents - birth, adoption, death of a dependent
  • Employment - change in employment status of employee, spouse or dependent to include termination, switching from part-time to full time or vice versa, return from an unpaid leave of absence
  • Dependent eligibility - situations where a dependent satisfies or ceases to satisfy the rules for eligible dependents due to the attainment of age or similar circumstances as provided in the plan
  • Annual election changes for changes in cost of coverage

Your employer is not required to include all of these status changes in your plan. You should check with your Human Resources office for the specifics of your Healthcare FSA plan.

What happens if my employment ends?

Deductions for your Healthcare FSA will also end when your employment ends unless your employer is obligated to offer you COBRA continuation and you elect this option. If your employer is not obligated to offer you COBRA and/or you choose not to elect COBRA, you are eligible to be reimbursed for qualified expenses incurred while you were employed and the account was active. Requests for reimbursements should be submitted prior to the end of your employer’s run-out period or period of time for which a claim for an expense can be submitted for a plan year that has ended or after an employee has terminated.