A Flexible Spending Account (FSA) is an IRS tax-favored account you can use to pay for dependent daycare & eligible health expenses (medical, prescription, dental, vision and approved Over-the-counter expenses) not covered by your insurance or any other plan (see rules and limitations in Your PayFlex Account Guide).
Flexible Spending Accounts feature:
- IRS approved reimbursement of eligible expenses tax-free
- Savings on Income and Social Security taxes
Under current federal tax law, unless the person qualifies as a dependent as defined by the IRS, expenses for that dependent cannot be claimed. Therefore, expenses for domestic partners, dependents of a domestic partner as well as Over Age Dependents age 26-30 cannot be reimbursed under a spending account.
"Use It of Lose It" Rule
FSA accounts are subject to the IRS “use or lose” rule. Unreimbursed amounts left in either Account cannot be returned to you. Claims must be incurred prior to 12/31/16 and submitted to PayFlex by 03/31/17. Under IRS regulations, unclaimed amounts are forfeited. For this reason we encourage you to be conservative in your estimates and only consider expenses you know you will incur in 2016.
Employees enrolled in a County CDH health plan: If you enroll in the Health Care FSA, all medical, prescription, dental and vision expenses for copays, co-insurance and deductibles will automatically be deducted from your Health Care FSA first. After the FSA account is exhausted, medical, prescription, dental and vision expenses can be reimbursed from your HRA.
Using the PayFlex Website
Logging into your PayFlex account is an important part of managing your account. Log in with your Employee ID or SS#.
Health expenses not covered by your insurance plan may be eligible for reimbursement using your FSA Health Care Account, including but not limited to:
- Eligible health, prescription, dental and vision copays, deductible, and/or co-insurance
- Limited over-the-counter (OTC) drugs
- Eyeglasses and contacts
- Dental expenses
Dependent care expenses, whether for a child or an elder, include any expenses that allow you to work, such as:
- Daycare services (child under 13, or adult)
- In-home care
- Nursery and pre-school
- Summer day camps
| Please refer to your PayFlex Account Guide on healthhub.com for plan details and rules. |
If you pay for eligible expenses with cash, check or a personal credit card, you can submit an online request for reimbursement. Or you can fill out a paper claim form and fax or mail it to PayFlex®. You may also use the PayFlex Debit Card®, your account bank card, to pay for your eligible expenses. When you use the card, the funds automatically come out of your Health Care FSA first.
Note: Save all of your receipts. If you have an Explanation of Benefits (EOB) from your insurance plan, save that too. When you submit a claim, you’ll need to submit the EOB or receipt.
Which expenses are not reimbursable?
The following is a partial listing of services or expenses that are not reimbursable under a Health Care FSA. For more information, please contact PayFlex Systems USA, Inc.
- Insurance premiums, including premiums for health insurance through another source
- Cosmetic surgery not deemed medically necessary to alleviate, mitigate or prevent a medical condition
- Health or fitness club membership fees
- Health care expenses for a domestic partner or dependents of a domestic partner
- Health care expenses for an Over Age Dependent (age 26 - 30)
Which expenses require proof of medical necessity?
Some prescription drugs or health care treatments require proof of medical necessity for reimbursement from your FSA. Below is a partial list of such expenses. For more information, please contact PayFlex Systems USA, Inc.
- Massage therapy
- Drugs that may be used for non-cosmetic reasons (e.g., Retin A, or that promote hair growth)
- Drugs or treatment programs for smoking cessation that have been prescribed for a specific life threatening medical condition (e.g., emphysema)
- Drugs or treatment programs for weight loss that have been prescribed for a specific life threatening medical condition (e.g., diabetes or heart disease)
What are the plan year contribution limits?
The current annual Health Care FSA pretax contribution limit is $2,550. If you and your spouse each have a Health Care FSA, you can each contribute $2,550.
The Dependent Care FSA limit is $5,000 per household/family. If you and your spouse each have a Dependent Care FSA, you are limited to $5,000 between the two of you.
Is documentation needed for reimbursement?
You must submit an itemized statement or detailed receipt when you submit a claim.
After you use your PayFlex card, you will also be asked to provide documentation to verify that expenses are eligible.
PayFlex Systems USA, Inc. (HealthHub)
Member Services: 800-284-4885
Section 125 Summary Plan Description - PDF printable