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Health Care Spending Account

What Is The Health Care Spending Account?
Who Is Eligible To Enroll?
Who Is Not Eligible To Enroll?
How Do I Enroll?
Eligible Expenses
Ineligible Expenses
Over-The-Counter Drugs
Changes In Status
HCSAccount Claims Process
Payroll Changes
What To Do At Tax Time
Saving With The HCSAccount
HCSAccount Frequently Asked Questions
Health Care Spending Account Worksheet
Health Care Spending Account Forms

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Health Care Spending Account Worksheet

To help you plan the amount of your HCSAccount contribution, use this worksheet. You may want to look at what you spent on health care last year before making your decision. Include annual estimated expenses for health care services anticipated for the upcoming plan year that will not be reimbursed by your medical, dental, or other benefit plans.

If you are enrolling during the open enrollment period, use the chart below to estimate your expenses for the 2017 calendar year. If you are joining the program during the year (that is, after the open enrollment period is over), use the chart to estimate your expenses for the remainder of the calendar year. If you are a new employee, your HCSAccount coverage won't begin until your 61st consecutive calendar day of employment.

Type of Expense Amount
per Year
MEDICAL EXPENSES, SUCH AS:
Health Plan Deductible
Office Visit and Hospital Copayments
Prescription Drug Copayments
Routine Physicals
Non-covered Prescriptions
Hearing Aids
Planned, Non-covered Medical Procedures
Other Eligible Expenses
DENTAL EXPENSES, SUCH AS:
Deductibles and Copayments
Routine Check-ups, Cleaning, and X-rays
Orthodontia
Non-cosmetic dental work (crowns, dentures, dental implants, etc.)
VISION CARE EXPENSES, SUCH AS:
Exams
Eyeglasses
Contact lenses & contact lens solutions
Total Expenses
Remember, your minimum contribution can be no less than $100 and your maximum contribution cannot exceed $2,550 for the tax year.



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Andrew M. Cuomo, Governor