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MEDICAL FSA FREQUENTLY ASKED QUESTIONS
Participants
A Health Care FSA is an employer-sponsored benefit that allows you to set aside money from your paycheck on a PRE-TAX basis to pay for certain out-of-pocket health care expenses for you and your eligible dependents.
FSA contributions and reimbursements are exempt from federal income taxes, Social Security (FICA) taxes, and in most cases, state income taxes. Depending on your tax bracket, you can expect savings between 22% and 38% on your elected amount.
Your annual election is divided among the number of paychecks you
have in the plan year and that amount is deducted from each check
PRIOR to being taxed. Once you incur an eligible expense, you can
request reimbursement from your account (up to your annual election
amount regardless of your contributions) either online or using a
hard copy form. Visit our
Filing Claims
page for specific details.
All expenses must be incurred during the plan year and while you
are an active participant, to be eligible for reimbursement*.
You "incur" an expense when you receive the service, not when you
pay the bill.
*Employers have been given the opportunity to extend their plan year by 21/2 months per IRS Notice 2005-42. Please check with your employer to see if they have elected to take advantage of this flexibility.
*Employers have been given the opportunity to extend their plan year by 21/2 months per IRS Notice 2005-42. Please check with your employer to see if they have elected to take advantage of this flexibility.
The maximum amount that you may contribute to your Health Care FSA is limited by your company's plan and may change from plan year to plan year. Please refer to your employer's Summary Plan Description for your plan's details.
Look at last year's out-of-pocket health care expenses to get the best idea. For additional help estimating your expenses use our
Expense Worksheet
and the FSA Calculator at
www.savesmartspendhealthy.com.
Keep in mind that starting January 1, 2011 any OTC drug or medicine purchase will require a doctor's
prescription before it can be reimbursed from your Flexible Spending Account.
You may only change your Health Care FSA election during the plan year if the requested change is due to and consistent with a qualifying event* such as:
- Change in marital status
- Change in dependent status
- Change in employment status
You can submit your request for reimbursement either online or
using a hard copy form. Visit our
Filing Claims
page for specific details. All medical claims must be accompanied
by receipts (or an Explanation of Benefits) that include the following information:
- Name of the person receiving the service
- Date of service
- Description of service
- Provider's name and address
- The portion of the expense you are required to pay after insurance benefits
If your employer offers this option, you can have your claims reimbursements automatically deposited to your checking
or savings account by completing a
Reimbursement Authorization Agreement
and submitting it to Planned Benefit Systems, Inc. via
fax/mail/email.
Direct deposit is a quicker and safer means of reimbursement.
Some of the items that are typically eligible include deductibles, co-payments, coinsurance, prescriptions, eyeglasses, corrective eye surgery, orthodontia and dental expenses.
However, under IRS guidelines, some health care services and products are only eligible for reimbursement from your Health Care Flexible Spending Account when your doctor or other
licensed health care provider certifies that they are medically necessary. In such case, a Certification of Medical Necessity (available with our
Forms
) must be provided.
Please remember that your practitioner's signature must be dated on or before the date of service or purchase.
Additionally, over-the-counter drugs and medicines are also eligible, when prescribed by a physician.
Starting January 1, 2011 any OTC drug or medicine purchase will require a doctor's prescription before it can be reimbursed from your Flexible Spending Account. The prescription date must be on or before the date of purchase of the OTC item. As a general rule, any OTC drug or medicine that you take orally or topically will require a prescription. Medical devices (such as monitors) and supplies (such as bandages and contact lens solution) will not require a prescription. Insulin and diabetic supplies are also items that will not require a prescription. See our Health Care Eligible Items List and Health Care Reform Web Page for more help.
Starting January 1, 2011 any OTC drug or medicine purchase will require a doctor's prescription before it can be reimbursed from your Flexible Spending Account. The prescription date must be on or before the date of purchase of the OTC item. As a general rule, any OTC drug or medicine that you take orally or topically will require a prescription. Medical devices (such as monitors) and supplies (such as bandages and contact lens solution) will not require a prescription. Insulin and diabetic supplies are also items that will not require a prescription. See our Health Care Eligible Items List and Health Care Reform Web Page for more help.
Cosmetic expenses, including teeth whitening are not eligible for reimbursement. Other typical ineligible expenses include (but are not limited to) vitamins, herbs, nutritional supplements, health club dues, hair growth medications, insurance premiums and expenses paid by your health and/or dental plans or other plans. Refer to your employer's
Summary Plan Description for any further restrictions.
Yes, you may use your Health Care FSA funds for eligible expenses related to all of your tax dependents. Their deductibles, co-payments and coinsurance can be reimbursed even if they are not covered by your medical and/or dental plans.
The claims filing deadline to submit an expense incurred during the plan year is typically 90 days after the plan year ends*. Pursuant IRS regulations, you will forfeit any money remaining in your account after the 90-day plan run out period.
*Employers have been given the opportunity to extend their plan year by 21/2 months per IRS Notice 2005-42. Please check with your employer to see if they have elected to take advantage of this flexibility.
*Employers have been given the opportunity to extend their plan year by 21/2 months per IRS Notice 2005-42. Please check with your employer to see if they have elected to take advantage of this flexibility.
You will have until the claims filing deadline to submit your eligible expenses incurred during the time you were an ACTIVE participant.
If you have a PBS Benefits Card, it will be deactivated upon termination, but you can request reimbursement either online or using a PBS Claim Form.
You may be eligible to continue in the plan after termination, ONLY if you had a positive account balance at termination and elect COBRA.
Click here
to log in to your account.
You can also reach a Customer Service Representative from 7:30am to 5:00pm MST/MDT, Monday
through Friday, at 303.221.2783 or toll-free at 800.800.0133.
You can also email us at help@pbs.us.com.
