Flexible Spending Account (FSA)
Information
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Who We Are
• ConnectYourCare is your health care account
administrator, offering the most advanced and userfriendly account solution.
– Online and mobile account
access
– Health education tools
– Payment card
– Easy access to funds
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Why Enroll? Savings Savings Savings!
How it works: Assume “Melissa” earns $35,000 a year and has $1,500 in
eligible expenses.
With FSA
No FSA
Annual Pay
$35,000
$35,000
Pre-tax HSA Contribution
-$1,500
-$0
=$33,500
=$35,000
-$7,362
-$7,852
-$0
-$1,500
=$26,138
=$25,648
$490
$0
Taxable Income
Federal income and
Social Security Taxes
Afer-tax dollars spent on
eligible expenses
Spendable income
Melissa’s Tax
Savings
*Sample tax savings for a single taxpayer with no dependents; actual savings will vary based on your individual
tax situation. Consult a tax professional for more information.
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What is an FSA?
Contributions
• You decide how much to contribute to your account up to the IRS
limit.
• Maximum annual contributions for Health FSA: $2,550
• Contributions are tax free and processed through payroll
Using Your Account
• Use the funds for your qualified medical expenses or those of your
spouse or your eligible dependents
• Total funds for the year are available when your plan becomes
effective (even if you have not contributed that amount yet)
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Funds Expiration
Funds Forfeiture
• Unused amounts at year-end are NOT rolled over to the
next plan year
• Plan wisely!
- OR Funds Rollover
• Unused amounts at year-end – up to $500 – are automatically
rolled over for use in the next year’s plan
• Carried over amounts do not count toward your contribution
limit for the following plan year
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Examples of Qualified Medical Expenses
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Acupuncture
Alcoholism treatment
Ambulance
Automobile modifications
for physically handicapped
Birth control pills
Braille books & magazines
Chiropractic care
Christian Science
practitioner
Contact lenses & related
materials
COBRA premiums
Crutches
Dental treatment
Dentures
Diagnostic services
Drug addiction treatment
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Eye examination
Eye glasses
Fertility treatment
Flu shot
Guide dog or other animal
aide
Hearing aids
Hospital services
Immunization
Insulin
Insurance premiums
Laboratory fees
Laser eye surgery
Long-term care premiums
or expenses
Medical testing device
Nursing services
Organ transplant
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Orthodontia
Physical exam
Physical therapy
Prescription drugs
Psychiatric care
Retiree medical insurance
premiums
Smoking cessation
program
Surgery
Sunscreen & sun block
(SPF15+, broad spectrum)
Transportation for medical
care
Weight loss program
necessary to treat obesity
Wheelchair
Examples of Qualified OTC Expenses
Some over-the-counter items are eligible for purchase with FSA funds.
Eligible without a
Prescription:
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Bandages
Braces & supports
Catheters
Contact lens supplies &
solutions
Denture adhesives
Diagnostic tests & monitors
Family planning items
First aid supplies
Insulin & diabetic supplies
Ostomy products
Reading glasses
Wheelchairs, walkers, canes
Eligible with a Prescription*:
Dual Purpose Items:
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These items can be used for a
medical purpose or for general health
and well being and are eligible only
with a prescription, doctor’s directive
or letter of medical necessity:
Allergy & sinus medicine
Antibiotics
Cold sore remedies
Cough, cold & flu
Feminine anti-fungal/anti-itch
Hemorrhoidal preps
Laxatives
Motion sickness
Pain relievers
Respiratory treatments
Sleep aids & sedatives
Stomach remedies
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Dietary and weight loss
supplements
Fiber supplements
Orthopedic shoes & inserts
Snoring cessation aids
Vitamins & herbal
supplements
* A “prescription” means a written or electronic order for a medicine or drug that meets the legal
requirements of a prescription in the state in which the medical expense is incurred and that is issued by an
individual who is legally authorized to issue a prescription in that state.
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Examples of Not Qualified Expenses
• COBRA premiums
• Concierge service fees (billed for
future services; no treatment
actually provided)
• Cosmetic surgery
• Exercise equipment
• Fitness programs
• Hair transplants
• Household help
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Illegal operations and treatments
Insurance premiums
Long-term care premiums
Maternity clothes
Retiree medical insurance
premiums
• Teeth whitening
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What is a Dependent Care FSA (DCAP)?
• Contributions
– You may contribute up to $5,000
to your account ($5,000 per
calendar year if single or married
filing jointly, $2,500 if married
filing separately)
– Contributions are tax free
• Using Your Account
– Use the funds for child or dependent care while you are at work – typical
expenses include day care, before and after school care
– Funds become available for use as you contribute them
• Funds Forfeiture
– Unused amounts at year-end are NOT rolled over to the next plan year
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Eligibility Requirements
To be reimbursed through your DCAP for child and dependent day
care services, you must meet the following conditions:
• You must have incurred the expenses in order for you and your
spouse, if married, to work or look for work, unless your spouse was
either a full-time student or was physically or mentally incapable of
self-care
• You cannot have made the care payments to someone you can claim
as your dependent on your federal tax return or to your child who is
under age 19
• You and your spouse must maintain a home that you live in for more
than half the year with the qualifying child or dependent.
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Qualified DCAP Expenses
Expenses for dependent care must be provided during
working hours.
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Before school or after school care (other than tuition expenses)
Licensed day care centers
Nursery schools or pre-schools
Placement fees for dependent care providers, such as au pairs
Child care at a day camp, nursery
school, or by a private sitter
Summer or holiday day camps
Late pick-up fees
Custodial care for dependent
adults
Care of an incapacitated adult
who lives with you at least
8 hours a day
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Not Qualified DCAP Expenses
• Expenses for children 13 and older
• Educational expenses including private school tuition
• Expenses for food, clothing, sports lessons, field trips and
entertainment
• Overnight camp expenses
• Registration fees
• Transportation expenses
• Late payment fees
• Payment for services not yet provided (payment in advance)
• Care for dependent while sick employee stays home
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Easy Access to Your Account
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Online Participant Portal
• 24 x 7 real-time access to:
– Obtain real-time account
balances
– Check transaction history on
accounts – contributions and
disbursements
– Submit online request for
reimbursement, check claim
status, and view reimbursement
schedule
– Add/update personal and direct
deposit information
– Access a variety of health
education and wellness tools
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Health Education Tools
• WebMD Hospital AdvisorSM— Hospital information
and rankings for specific procedures
• WebMD Medication AdvisorSM— Information on less
expensive prescription options
• WebMD Treatment Cost AdvisorSM— Cost estimates
on 350 of the most common medical conditions, tests,
and procedures
• WebMD Health TopicsSM— A to Z medical
encyclopedia listing of over 1,500 ailments with
information, treatment options, prevention, and more
• WebMD HealthQuotientSM— State-of-the-art
assessment tool that scores participants’ health status,
calculates risk levels, and provides recommendations
for health improvement and behavior change
• Symptom Checker — Information about what medical
symptoms could indicate and helpful facts before a
doctor’s visit
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Mobile Solutions
• Mobile App
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Available for Android, iOS and Windows devices
View account balance, alerts and transaction history
Submit a new claim
Make payments with Online Bill Pay and Click-to-Pay
Tap to call Customer Service
Upload claim documentation with your device’s camera
• Mobile Browser
– Streamlined version of online account viewable from any
mobile device
– Access many of the Mobile App’s features without having to
download it
• Mobile Alerts and Two-Way Texting
– Request and receive account information and alerts via text
message
– Sign up for this feature through your online account
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Accessing Account Funds
Payment Card for Health FSA
• Use it at locations where Visa is
accepted
• Use it for qualified health care
expenses
• Automatically records purchase online
• Money comes directly out of your
account
• No need to pay upfront and wait for
reimbursement
• Cannot be used at ATMs
• Multiple ConnectYourCare accounts
are accessible with the same card (if
offered by your employer)
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Reimbursement Requests
Pay with personal funds and request reimbursement for all
DCAP claims and any Health FSA purchases made without
your card.
• Pay for a qualified expense using personal funds
• Enter your claim online or using the mobile app
• Upload documentation
online or with mobile app
• Receive reimbursement
via check or direct
deposit
Tip: Set up direct deposit
for faster reimbursements!
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Receipts Overview
• IRS requires all charges to be
verified as an eligible expense
• Some expenses are verified
automatically, all others require
itemized receipts
• Payment card will be suspended
if itemized receipts are not
submitted
• Receipts must include:
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Name of the patient
Date the service was provided
Name of the service provider
Description of the service
Amount/cost of the item or service
required
Tip: Your health plan EOB typically contains
all the required information!
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Submitting Receipts
• Many ways to submit
receipts:
– Mobile upload – snap a picture
with your phone!
– Online upload – quickly and
easily upload a scanned image
– Fax – Print out a cover form from
your online account. Each barcoded claim form is unique, be
sure to use the one designated
for that claim.
– USPS mail – Print out a cover
form from your online account
mail it along with a copy of your
receipts.
• View uploaded images
immediately
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Customer Service Always Available
Best-in-class service to participant through multiple channels
• Live Customer Assistance
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Available 24/7, 365 days a year
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Detailed questions or personal assistance
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Trained in adjudication and call assistance
• Interactive Voice Response
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Account information
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User name reminder or password reset
• Online Portal, Mobile App, Mobile
Browser and Mobile Alerts
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Real-time account balances and transaction
information
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Frequently Asked Questions
How will I be able to access my account funds?
You will receive a payment card to access your Health FSA funds. For DCAP expenses and
charges not using your payment card, you can also pay for eligible expenses with any other form of
payment and request reimbursement from your account.
When can I request reimbursement from my account?
You have access to the account when your plan becomes effective.
How will I know if I need to submit a receipt to ConnectYourCare for
substantiation?
If a receipt is needed, you will be notified by email or letter within a week of your payment card
swipe. You can also check by logging into your account and visiting the Claim Center.
What if I don’t submit my receipts?
You must provide the receipts within the time requested, or the transaction will be deemed
ineligible, and you will be required to refund the amount of the transaction. If you fail to submit
required receipts, your payment card will be deactivated. If you fail to reimburse the account, the
amount of the ineligible expenses may be added to your W-2 or withheld from your pay.
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