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What Is The Health Care Spending Account?
The Health Care Spending Account (HCSAccount) is a negotiated employee benefit that helps State employees pay for health-related expenses with tax-free dollars. This includes medical, hospital, laboratory, prescription drug, dental, vision, and hearing expenses that are not reimbursed by your insurance or other benefit plans.
Before participating in the HCSAccount program, you should carefully consider what your eligible expenses might be. Reviewing your expenses from previous years can help. Once you have estimated the amount of your expenses, you may then determine how much to contribute to your HCSAccount. Under federal law, any money that you put into your HCSAccount must be used for expenses incurred during the plan year in which it was contributed. For the 2008 plan year, the maximum annual contribution allowed by the program is $4,000 and the minimum annual contribution is $100.
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Who Is Eligible To Enroll?
1. Employees who work for New York State Executive Branch State agencies (excluding UUP-represented employees), employees of the Legislature and non-judicial employees of the Unified Court System are eligible if they:
- are permanent employees or are expected to be on the payroll for the entire 2008 calendar year (employees who teach on a school-year schedule and are paid on a 10-month basis are eligible if they meet the other criteria below)
- are employed on an annual-salaried basis
- receive regular, bi-weekly paychecks
- work half-time or more on a regular schedule for a single agency
- are eligible to enroll in the New York State Health Insurance Program
- are represented by a negotiating unit that is eligible to participate, or are designated Management/Confidential. For the 2008 plan year, employees of Executive Branch State agencies who are represented by one of the following unions are eligible to participate in the HCSAccount: CSEA, PEF, NYSCOPBA, Council 82, District Council 37, PBA, and NYSPIA. In addition, all negotiating units in the Unified Court System are eligible to participate.
Employees of the Roswell Park Cancer Institute, NYS Energy Research and Development Authority, Environmental Facilities Corporation, and NYSTAR are also allowed to participate if they meet the eligibility criteria listed above.
All judges and justices of the Unified Court System, and paid elected officials and paid members of the legislative body are eligible regardless of their work schedule.
2. UUP-represented employees employed by the State University of New York are eligible if they:
- are permanent employees or are expected to be employed by New York State for the entire 2008 calendar year (employees who are hired on a semester basis are eligible if they meet the other criteria below) and
- receive regular, bi-weekly paychecks and
- are eligible to enroll in the New York State Health Insurance Program and
- are academic employees who teach two or more courses per semester at a single university or
- are full-time professional employees or
- are part-time academic or professional employees who are hired at a specified annual rate at a single university ($12,205 or more between July 2, 2007 and July 1, 2008).
3. New employees must meet the eligibility criteria to participate in the HCSAccount. New employees who are hired on or before October 31, 2007 must enroll during the 2008 open enrollment period in order to participate in the Flex Spending Account for 2008. New employees who are hired on or after November 1, 2007 and wish to participate in the Flex Spending Account for 2008 must either enroll during the 2008 open enrollment period or submit a change in status application within 60 days of their employment start date. Your eligibility period will start on your 61st consecutive day of State employment and you will be able to seek reimbursement for eligible health care expenses incurred on or after that date through December 31 of the plan year in which you are enrolled. Deductions will start with the first payroll date that occurs after you become eligible to submit claims.
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Who Is Not Eligible To Enroll?
Casual, seasonal, session, per diem, fee basis and hourly employees, retirees, and employees of the SUNY Research Foundation, HRI, and NYS Thruway Authority are not eligible to participate in the HCSAccount.
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How Do I Enroll?
You have an opportunity to enroll in the HCSAccount each fall during the
open enrollment period. For the 2008 plan year, the enrollment period begins September 24, 2007 and concludes November 16, 2007.
- Use the Health Care Spending Account Worksheet to help you estimate your out-of-pocket health care expenses for the 2008 plan year. Include only those health care expenses that will occur after the plan year begins. You may include expenses for you, your spouse, your qualifying children, and your qualifying relatives. You should also verify with your health care provider that you are a suitable candidate for any surgical procedure, such as laser eye surgery, before committing the money to your account.
- Based on your estimate, decide how much of your salary ($100 to $4,000) you want to set aside in your HCSAccount. The amount you choose is taken out of your paycheck through automatic payroll deductions. The number of payroll deductions will be determined based on the number of paychecks you expect to receive during the plan year. If you expect to be on the New York State payroll for the entire year, deductions will be taken from a maximum of 24 paychecks.
- You can enroll in the HCSAccount online. Select "Apply Now" from the menu and follow the instructions on the screens. If you are not enrolled in 2007, you will be prompted to register as a first time user, including completing a user information page and creating a user ID and password (user IDs will be mailed to re-enrollees in mid-September). Indicate the amount of your annual election for the 2008 plan year, as well as the number of paychecks you expect to receive for the year. Once you complete the online enrollment application, click the "Submit My Application" button and you are done. The process is quick, easy, and secure. Be sure to print a copy of your application for your records.
If you do not have Internet access, you can also enroll by simply calling FBMC at 1-800-358-7202. A Customer Service Representative (CSR) will ask you all the information needed for your enrollment application.
- If you do not enroll in the HCSAccount when you are first eligible, you must wait until the next open enrollment period, unless you experience an event that would permit a mid-year election change. Please note that State University of New York employees who are otherwise eligible for this program but only work during the fall semester may not enroll during the open enrollment period, Rather, they must submit a Change in Status application to enroll when they return to work for the fall semester.
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Eligible Expenses
To be reimbursed through the HCSAccount, expenses must be for health care received primarily for the prevention or treatment of a physical or mental defect or illness. Out-of-pocket expenses are generally eligible if they are not reimbursed by insurance. Regardless of whether the expenses are incurred by you or your eligible dependents, they must be incurred during the plan year or during your period of coverage if you enroll after the plan year begins. An expense is incurred when you or one of your dependents receives the health care service, not when you are billed, charged for, or pay for the service. To be eligible for reimbursement, a health care expense must be:
- for you or an eligible dependent
- permitted under the Internal Revenue Code
- medically necessary
- not reimbursed by your health insurance or any other benefit plan, nor will you seek reimbursement from such plans
Whose expenses are eligible for reimbursement?
You may claim eligible expenses under the HCSAccount program for the following individuals:
- yourself
- your spouse
- your qualifying child
- your qualifying relative
An individual is a qualifying child if he/she:
- is a U.S. citizen, national, or a resident of the U.S., Mexico, or Canada
- has a specified family-type relationship to you
- lives in your household for more than half of the taxable year
- is 18 years old or younger (23 years, if a full time student) at the end of the taxable year
- has not provided more than one-half of his/her own support during the taxable year (and receive more than one-half of his/her support from you during the taxable year if a full time student age 19 through 23 at the end of the taxable year)
An individual is a qualifying relative if he/she:
- is a U.S. citizen, national, or a resident of the U.S., Mexico, or Canada
- has a specified family-type relationship to you, is not someone else’s qualifying child, and receives more than one-half of his/her support from you during the taxable year
or
if no specified family-type relationship to you exists, is a member of and lives in your household (without violating local law) for the entire taxable year and receives more than one-half of his/her support from you during the taxable year
Note: There is no age requirement for a qualifying child if he/she is physically and/or mentally incapable of self care. An eligible child of divorced parents is treated as a dependent of both, so either or both parents may establish a HCSAccount to be reimbursed for the child’s health care expenses.
According to the IRS, a domestic partner's health care expenses are eligible for reimbursement through a HCSAccount only if the domestic partner is a qualifying relative under the Internal Revenue Code.
What types of expenses are eligible?
An extensive list of medical expenses that can be deducted on Schedule A of Form 1040 appears in IRS Publication 502 (Medical and Dental Expenses), although Publication 502 should not be solely relied upon to determine your eligible expenses under the HCSAccount. For example, expenses such as insurance premiums are deductible on Schedule A, but are not eligible for reimbursement through the HCSAccount. In addition, the IRS allows you to deduct an expense if it is paid during the tax year, while HCSAccount claims are reimbursed only if an expense is incurred during the plan year. Also, expenses that are reimbursed through your HCSAccount may not also be deducted on Schedule A. Examples of eligible expenses under the Health Care Spending Account are listed below:
Eligible
Acupuncture 1
Alcoholism treatment
Ambulance services
Artificial limbs 3
Chiropractic care
Christian Science practitioners
Contact lenses
(corrective)
Contact lens
solutions
Copayments
Crutches
Deductibles
Dental fees 1
Dentures
Diagnostic tests
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Drug addiction treatment
Drugs
(prescription only) 2
Eye examinations
Eyeglasses 3
Guide dog expenses
Hearing aids & exams
Holistic healers
Infertility treatments
Insulin
Laboratory fees
Laser eye surgery 4
Naturopathic healers
Orthopedic shoes
Orthodontic treatment
Oxygen
Nursing services 1
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Psychiatric care
Periodontal fees
Physical therapy
Smoking cessation
programs/ treatments
Surgery 1,4
Telephone for the
hearing-impaired
Transplants of organs
Transportation 5
Vaccinations
Weight loss programs 6
Wheelchairs
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1 Some health care treatments or services, including those deemed cosmetic in nature, require written proof of medical necessity from your health care provider with your initial reimbursement request and for each subsequent plan year that you participate.
2 Not all drugs requiring a prescription are approved by the IRS as eligible for reimbursement. Prescription drugs that are used solely for cosmetic purposes are not eligible for reimbursement.
3 The effective date that expenses are incurred (for example, eyeglasses and prosthetic devices) is the day the item is available to be picked up, not the date ordered.
4 Unused funds designated for the HCSAccount cannot be refunded to you. Please verify with your health care provider (prior to enrolling for the upcoming plan year) that you are a suitable candidate for any surgical procedure before committing the money to your HCSAccount.
5 Must be primarily for, and essential to, medical care. Reimbursable expenses include 19 cents per mile for January 1, 2008 through June 30, 2008, and 27 cents per mile for July 1, 2008 through December 31, 2008 (20 cents per mile in 2007) for automobile use, parking fees, tolls, subways, buses, trains and air travel.
6 Expenses incurred for weight loss programs and special foods may only be reimbursable if a physician prescribes the treatment as medically necessary to prevent, treat, or alleviate a specific, diagnosed medical illness (such as hypertension, diabetes, or obesity).
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Ineligible Expenses
Certain health care expenses are not eligible for reimbursement from your HCSAccount, some of which are listed below:
Ineligible
Cosmetic procedures
Cosmetic surgery
Dance lessons
Dietary Supplements
Electrolysis
Exercise equipment1
Fitness programs1
Glucosamine/condroitin
Hair transplants
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Health club memberships
Herbal remedies
Holistic medicines
Homeopathic remedies
Insurance premiums
Marriage counseling
Massage therapy1
Over-the-counter drugs2
Over-the-counter supplies2
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Smoking cessation
drugs
(over-the-counter)2
Teeth whitening/bonding
Vision warranties
Vision service contracts
Vitamins1,2
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1 May be an eligible expense if prescribed by a doctor to treat a specific medical condition. Written proof of medical necessity is required.
2 Beginning January 1, 2004, over-the-counter drugs and expenses are reimbursable for certain employees.
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Over-The-Counter Drugs
Over-the-counter (OTC) drug expenses are reimbursable through the HCSAccount for certain employees. Reimbursable expenses include allergy remedies, antacids, cold medicines, and pain remedies.
For the 2008 plan year, the following employee groups are eligible for OTC drug reimbursement: CSEA, PEF, UUP, M/C, NYSCOPBA (BU 01), PBA, NYSPIA, DC-37, ALES, Council 82 Security Supervisors Unit, all negotiating units in the Unified Court System, and employees of the Legislature. Pending the outcome of negotiations, OTC drug coverage may be extended to additional State employee groups at a later date. Check this web site or call 1-800-358-7202 to find out if you are a member of an employee group that is eligible for OTC drug reimbursement.
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Changes In Status
You must enroll during the open enrollment period, unless you have a change in status event that occurs after the open enrollment deadline.
Once enrolled in the HCSAccount, you may not change your mind. Your pre-tax deductions will continue throughout the plan year. However, there are certain circumstances where a change in your annual election may be permitted, as long as the change is consistent with the change in your family situation. For example, if you become married during the plan year, you may increase the amount of your contribution, and if you lose a dependent during the plan year, you may reduce the amount of your contribution. However, you are not allowed to reduce your election amount to $0 if you have a change in status. Certain events, such as marriage, the birth of a child, or returning to work from an unpaid leave of absence, will allow you to enroll during the year. Below is a list of eligible changes in status (CIS):
- Change in legal marital status such as marriage, death of spouse, divorce, legal separation, or annulment
- Change in number of eligible dependents due to birth, death, adoption, or placement for adoption
- The taking of, or return from, an unpaid leave of absence for the employee
- Beginning or end of employment for the employee
- Gain or loss of spouse's or eligible dependent's eligibility for health insurance coverage due to a change in employment
- Gain or loss of your dependent's eligibility for health insurance by attaining a specified age, due to a change in student or marital status, or because of any other circumstance
Starting mid November 2007 if you have a CIS, call Customer Service for a change in status application. Your change in status application must be received within 60 calendar days of the qualifying event, but as promptly as possible to prevent unwanted, non-refundable deductions. You will also need to include documentation to support the change request, such as a copy of a marriage license, divorce decree, birth certificate, adoption decree, or death certificate.
The effective date of your new period of coverage will generally be the date your application is received by the FSA Administrator, unless you are a new employee. In addition, if you are enrolled in the HCSAccount when the plan year begins on January 1 and you submit a change in status request during the plan year, you will have two distinct periods of coverage from which expenses must be incurred and will be reimbursed.
Change in status applications will be accepted during the plan year for events that occur on or before November 15. Applications received after November 15 won’t be accepted because they can’t be processed in time for the last payroll deduction of the year.
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HCSAccount Claims Process
How do I file a claim for health care expenses?
To request reimbursement for health care expenses under the HCSAccount, you must complete the HCSAccount reimbursement request form (PDF) and provide proper documentation. Filing a claim is easy. Here's how:
- Receive health care services. A health care service expense is incurred when the services are provided that create the expense. You must receive health care services before you file a claim for reimbursement. However, if you are on a monthly payment plan for orthodontia services, you may submit a request for reimbursement after each monthly payment is due, even if no office visit takes place during that month. A copy of the orthodontia contract must be included with your first claim for the plan year.
- Use the reimbursement request form (PDF) provided by FBMC and list each separate eligible expense individually on the claim form.
- Attach a statement from your health insurance plan showing the amount of the medical expense that has not been reimbursed or attach copies of receipts, billing statements, invoices, or other appropriate supporting documentation from the health care provider. Cancelled checks or credit card receipts will not be accepted. The receipts, billing statements, or invoices must include the:
- name of the person for whom the service was provided
- name and address of the health care provider
- amount charged for each service
- type of service and the date performed
- if a prescription drug expense, a receipt containing the prescription number and drug name
- Submit claims to FBMC after you have received health care services and know the amount of the bill for which you are responsible. All completed reimbursement request forms and supporting documentation must be mailed or faxed directly to FBMC.
Remember, when the plan year ends on December 31, you still have 90 days to send in a reimbursement request form (PDF) for expenses you incurred during the plan year. So, you have until March 31 to submit claims for services rendered from January 1 through December 31 of the preceding year.
Note: You can only be reimbursed for expenses that are incurred during your period of coverage.
- If you enroll during the open enrollment period and remain on the State payroll for the entire year, your period of coverage is from January 1 to December 31.
- If you enroll during the plan year as a new employee, your period of coverage will begin after the completion of 60 consecutive calendar days of State service and end on December 31.
- If you enroll during the plan year as a result of a change in status, your period of coverage will begin when your change in status application is received, although it cannot precede the date of your qualifying event.
- If you enroll during the open enrollment period and experience a mid-year change in status, you will have two separate periods of coverage from which expenses will be reimbursed.
When will I be reimbursed?
The FSA Administrator will review your reimbursement request form and supporting documentation and, if they are complete, will authorize payment. You will receive a reimbursement check once your claim is approved. You can also Enter the RACE (PDF) for direct deposit of your reimbursements into your checking or savings account.
No reimbursement can be made prior to the service actually being provided. However, once you sign up for the HCSAccount and decide how much you want to contribute, that total amount is available to you at any time during your period of coverage. It's like a cash advance because you don't have to wait for the cash to accumulate in your account before you can use it to pay for your unreimbursed, eligible health care expenses. Your money is tax free and interest free!
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Payroll Changes
What happens if I leave the payroll during the plan year?
If you leave the payroll due to termination of employment, leave without pay (including leave under the Family and Medical Leave Act), or any other reason, and stop contributing to your account, your eligibility in the HCSAccount will be terminated. You will still be able to submit claims for expenses that occur on or before your last paycheck deduction, but any health care expenses that occur after your contributions stop will not be reimbursed.
However, under certain circumstances you may still continue participating in the HCSAccount after you leave the payroll:
- If you are eligible to elect COBRA coverage, you can make after-tax payments directly to FBMC, although under the direct pay option, you won't save money on your taxes. If you leave the payroll during the plan year (either temporarily or permanently) and want to continue your coverage, FBMC will send you a COBRA notice that you must sign and return by the specified deadline.
- If you retire, terminate employment, or take a planned leave of absence (such as under the Family and Medical Leave Act) you can pre-pay your election by increasing the amount of your biweekly deductions to compensate for the deductions you expect to miss once you leave the payroll. If you choose this option, you must contact the plan via email (fsa@goer.state.ny.us) as soon as possible to arrange for your deductions to be adjusted before you receive your last paycheck.
- If you return to the payroll during the same plan year, you can re-enroll if you submit a change in status application within 60 days of your return to work. CIS applications will be accepted during the plan year until November 15.
- If you leave and then return to the payroll, you may re-enroll, but only for the same election amount that you had at the time you left the payroll. However, as with any mid-year change in status, you will then have two distinct periods of coverage from which expenses must be incurred and will be reimbursed.
Remember, even if you re-enroll in the HCSAccount after you return to the payroll, you will not be reimbursed for health care expenses incurred while you stopped contributing to your account.
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Saving With The HCSAccount
The following is an example of the HCSAccount tax advantage based on the 2006 federal and state income tax tables. The projections made on this sheet are only estimates of tax information and should not be assumed to be tax advice. We also encourage you to use the HCSAccount online calculator to help estimate your potential savings based on your specific situation, but keep in mind the amount of your tax savings cannot be guaranteed. Be sure to consult a tax advisor if you require tax advice for your financial situation.
Tax Savings Example
| A single employee earns $53,000, declares 2 dependents, and files as head of household. The annual HCSAccount contribution is $1,300 and the employee incurs $1,300 in reimbursable health care expenses. |
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With HCSAccount |
Without HCSAccount |
Savings With HCSAccount |
| Annual Income |
$53,000 |
$53,000 |
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| Expenses Paid through HCSAccount |
-1,300 |
-0- |
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| Adjusted Gross Income |
$51,700 |
$53,000 |
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| Federal Income Tax |
-4,596 |
-4,791 |
$195 |
| State Income Tax |
-2,124 |
-2,210 |
86 |
| Social Security Tax |
-3,955 |
-4,055 |
100 |
| After-Tax Cost of Health Care Expenses |
-0- |
-1,300 |
_______ |
| Your Spendable Income (assuming there are no other payroll deductions) |
$41,025 |
$40,644 |
$381 |
| This employee could save $381 in taxes by using the HCSAccount! |
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HCSAccount Frequently Asked Questions
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How do I know if I should enroll in the HCSAccount? |
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Is an employee required to participate in the New York State Health Insurance Program (NYSHIP) in order to participate in the HCSAccount? |
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Does the HCSAccount replace my medical plan? |
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Whose expenses are eligible for reimbursement under the HCSAccount program? |
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Are my domestic partner's health care expenses eligible for reimbursement from my HCSAccount? |
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Can the HCSAccount pay my doctor directly? |
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If my spouse and I are State employees, can we both enroll in the HCSAccount? |
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Can I request reimbursement from the HCSAccount program for services I receive before the plan year begins if I am not billed until after the plan year starts? |
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Are dental implants reimbursable? |
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What happens if my medical expenses change during the plan year? Can I increase or decrease my HCSAccount contributions? |
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Can health care services that require up-front payment to the provider be reimbursed from the HCSAccount in a single plan year, even if the health care is delivered over several plan years? |
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Are expenses that are reimbursed by the HCSAccount eligible to be deducted on my federal tax return as a medical expense? |
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Can travel expenses related to my medical care be reimbursed through my HCSAccount? |
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Will the HCSAccount reimburse the cost of my prescription drug, even if my insurance plan won't pay for part of it? |
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Can over-the-counter drugs, herbal medicines and homeopathic remedies be reimbursed if my doctor or medical provider prescribes them to treat my medical condition? |
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If I should incur an eligible change in status can I increase or decrease my HCSAccount amount? |
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If I leave State service or take an unpaid leave of absence before the end of the year, what happens if the reimbursements I have received during the plan year are greater than the amount of money I have contributed to my account? Do I have to pay any of it back? |
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Will the Plan pay for upgrades to my prescription glasses? |
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How do I know if my child's orthodontia will be reimbursed? How are orthodontic expenses reimbursed if I pay my provider on a monthly payment plan? |
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If I am divorced and my divorce decree allows my ex-spouse to claim our child as a dependent at tax time, can I still use my HCSAccount to pay for my child's unreimbursed health care expenses? |
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What happens if I retire, terminate employment with the State, or take an unpaid leave of absence during the year? |
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What happens to the money in my account if I separate from State service during the plan year? Can I use it after I leave? |
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I am an adjunct professor at a State University, and don’t expect to receive paychecks during the summer months. Will that affect my participation in the HCSAccount? |
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If my spouse or I have health insurance coverage elsewhere, can I still enroll in or use the HCSAccount to pay for my family’s expenses? |
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If I was not eligible to enroll in the HCSAccount during the open enrollment period, but gain eligibility during the plan year, can I enroll mid-year? |
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| Q |
How do I know if I should enroll in the HCSAccount? |
| A |
If you answer "yes" to any of the following questions, and pay income taxes, you can save money if you enroll in the HCSAccount:
- Do you expect to pay deductibles and copayments under your medical, dental, and prescription drug insurance plans during the next year?
- Is anyone in your family planning on receiving orthodontia or other dental treatment during the next year?
- Are you or another family member planning to undergo a non-cosmetic medical procedure that is either not covered or only partially covered under your health insurance plan?
- Is anyone in your family planning on buying a hearing aid, corrective contact lenses or eyeglasses, and expecting to pay more than your health insurance plan will allow?
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| Q |
Is an employee required to participate in the New York State Health Insurance Program (NYSHIP) in order to participate in the HCSAccount? |
| A |
No. If an employee has coverage elsewhere, he or she may still enroll in the HCSAccount as long as the eligibility criteria for the program are met. |
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| Q |
Does the HCSAccount replace my medical plan? |
| A |
No. This program offers you a way to pay for eligible out-of-pocket health care expenses with pre-tax money. You cannot submit expenses for which you have received or will seek reimbursement from your health care plan or other source. So, you should first submit your claims to your health care plan so that it can pay according to the Plan limits. Then, the remaining out-of-pocket eligible expenses can be submitted to the HCSAccount for reimbursement. |
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| Q |
Whose expenses are eligible for reimbursement under the HCSAccount program? |
| A |
The HCSAccount may be used to reimburse health care expenses for you, your spouse and anyone who is defined as a qualifying child or qualifying relative by the Internal Revenue Code. |
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| Q |
Are my domestic partner's health care expenses eligible for reimbursement from my HCSAccount? |
| A |
According to the IRS, health care expenses for a domestic partner cannot be reimbursed through a HCSAccount unless the domestic partner is a qualifying relative under the Internal Revenue Code. |
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| Q |
If my spouse and I are State employees, can we both enroll in the HCSAccount? |
| A |
Yes. Any eligible State employee may enroll in the HCSAccount, up to the maximum contribution of $4,000 per individual. However, if both spouses enroll, each health care expense can only be reimbursed once. |
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| Q |
Can I request reimbursement from the HCSAccount program for services I receive before the plan year begins if I am not billed until after the plan year starts? |
| A |
No. According to IRS guidelines, a qualified expense is "incurred" at the time the service is provided, not when you are billed (or charged) or actually pay for the service. Therefore, reimbursements made during a plan year are only for eligible expenses incurred during that same plan year. |
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| Q |
Can the HCSAccount pay my doctor directly? |
| A |
No. Payment is made only to the enrollee. |
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| Q |
Are dental implants reimbursable? |
| A |
Yes, dental implants are reimbursable as long as they are not a cosmetic treatment. |
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| Q |
What happens if my medical expenses change during the plan year? Can I increase or decrease my HCSAccount contributions? |
| A |
No. According to IRS rules, a change in medical expenses is not a qualifying event that would allow you to change the amount of your HCSAccount annual election. So, if you incur more medical expenses during the plan year you cannot increase your HCSAccount contributions, and if your medical expenses are less than you had planned, you cannot reduce your HCSAccount contributions. |
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| Q |
Can health care services that require up-front payment to the provider be reimbursed from the HCSAccount in a single plan year, even if the health care is delivered over several plan years? |
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No. IRS regulations do not allow medical expenses to be reimbursed through the HCSAccount until they have been incurred. Expenses are not incurred until treatment is provided to the participant, regardless of when the participant pays the provider. |
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| Q |
Are expenses that are reimbursed by the HCSAccount eligible to be deducted on my tax return as a medical expense? |
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No, because you have already received reimbursement with tax-free dollars. Only expenses that are not reimbursed through an insurance plan, some other source, or the HCSAccount may be claimed on your income tax return. |
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| Q |
Can travel expenses related to my medical care be reimbursed through my HCSAccount? |
| A |
Yes. The IRS permits you to be reimbursed for amounts paid for transportation primarily for, and essential to, medical care. You can receive reimbursement for car mileage (19 cents per mile for January 1, 2008 through June 30, 2008, and 27 cents per mile for July 1, 2008 through December 31, 2008), parking fees, tolls, subways, buses, trains, air travel, and lodging if the costs are incurred primarily to receive medical care. |
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| Q |
Will the HCSAccount reimburse the cost of my prescription drug, even if my insurance plan won't pay for part of it? |
| A |
Any prescription drug can be reimbursed as long as it is used to treat a medical condition. Prescription drugs that are primarily used for cosmetic purposes can't be reimbursed. |
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| Q |
Can over-the-counter drugs, herbal medicines and homeopathic remedies be reimbursed if my doctor or medical provider prescribes them to treat my medical condition? |
| A |
Over-the-counter drugs and supplies are reimbursable if you are a member of a bargaining unit that is eligible for such coverage. Herbal medicines and homeopathic remedies are not reimbursable under the HCSAccount. |
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| Q |
If I should incur an eligible change in status can I increase or decrease my HCSAccount amount? |
| A |
Yes, however your change must be consistent with the event. The IRS requires that the FSA Administrator treat the periods prior to and subsequent to the change as two separate periods of coverage for reimbursement purposes. |
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| Q |
If I leave State service or take an unpaid leave of absence before the end of the year, what happens if the reimbursements I have received during the plan year are greater than the amount of money I have contributed to my account? Do I have to pay any of it back? |
| A |
If you have been reimbursed more money than you have contributed to the Plan, you are not required to pay the money back when you leave the payroll. |
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| Q |
Will the Plan pay for upgrades to my prescription glasses? |
| A |
Yes. You can be reimbursed for the cost of upgrades or add-ons (such as scratch-resistant coating) to your prescription lenses and frames. There is no limit on dollar amounts of the upgrades or add-ons. Non-prescription glasses and sunglasses are not reimbursable. |
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| Q |
How do I know if my child's orthodontia will be reimbursed? How are orthodontic expenses reimbursed if I pay my provider on a monthly payment plan? |
| A |
Orthodontic expenses are reimbursable if they are not cosmetic in nature. At the beginning of the plan year in which you first request reimbursement for these expenses, you must submit a copy of the service contract between you and the orthodontist describing the payment arrangement/schedule.
Orthodontia costs that are paid on a monthly payment plan will be reimbursed after each monthly payment is due. However, if you pre-pay the entire cost of orthodontia treatment up front, you will only be reimbursed in a particular plan year for the value of the services that will be provided during that plan year. |
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| Q |
If I am divorced and my divorce decree allows my ex-spouse to claim our child as a dependent at tax time, can I still use my HCSAccount to pay for my child's unreimbursed health care expenses? |
| A |
Yes, the IRS still considers your child as a dependent for your HCSAccount, so you may submit your child's medical claims to the Plan for reimbursement. |
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| Q |
What happens if I retire, terminate employment with the State, or take an unpaid leave of absence during the year? |
| A |
If you retire, terminate employment, or take an unpaid leave of absence during the plan year, your coverage will be terminated once you leave the payroll and stop contributing to your account, unless you plan ahead during open enrollment. You can contribute your full annual election before you leave the payroll, which will enable you to use your account for expenses incurred after you leave. When you apply for enrollment, make sure to indicate the number of paychecks you expect to receive before you leave the payroll. If you are unable to plan ahead, you may still continue to participate in the HCSAccount by making after-tax COBRA payments directly to FBMC, or by arranging to pre-pay the balance of your annual election before you leave the payroll. Email the Plan at fsa@goer.state.ny.us if you wish to arrange pre-payments. |
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| Q |
What happens to the money in my account if I separate from State service during the plan year? Can I use it after I leave? |
| A |
If you retire, leave State employment, go on leave without pay, or otherwise stop contributing to your account, the money in your account can only be used for services that occurred before you left the payroll. However, if you continue to contribute to the HCSAccount after you leave the payroll by making after-tax payments directly to FBMC, or if you pre-pay the balance of your annual election before leaving the payroll, you will be able to submit claims for services that occurred after you leave your State job. |
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| Q |
I am an adjunct professor at a State University, and don’t expect to receive paychecks during the summer months. Will that affect my participation in the HCSAccount? |
| A |
Yes. If you are an adjunct employee and leave the payroll at the end of the spring semester, your eligibility will be terminated once you stop contributing to your account. However, if you plan ahead during the open enrollment period and select the option of contributing your full annual election by the end of the spring semester, your participation will continue uninterrupted after you leave the payroll. |
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| Q |
If my spouse or I have health insurance coverage elsewhere, can I still enroll in or use the HCSAccount to pay for my family’s expenses? |
| A |
Yes. You can participate in the HCSAccount even if you are not enrolled in the New York State Health Insurance Program. |
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| Q |
If I was not eligible to enroll in the HCSAccount during the open enrollment period, but gain eligibility during the plan year, can I enroll mid-year? |
| A |
No. A change in eligibility is not a change in status event that would allow you to enroll in the HCSAccount during the plan year. |
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