Overview
The County's third party administer is Fringe Benefits Management Company (FBMC). They administer BOTH the HRA and FSA program.
Click here to set up your personal, secure, account.
Handbook 2008 FBMC Book -- (PDF 1000 Kb)
HRA (Health Reimbursement Account)
The following expenses incurred for covered services under a Consumer Driven Health Plan and can be reimbursed through your HRA:
- Co-pays
- Co-Insurance
- Deductible
- RX (See Below)
The following expenses are not reimbursable from the HRA
- Dental claims
- Vision claims
- Non-covered health services
- Complimentary and alternative medicine
Guidelines for pharmacy co-pay reimbursement from your HRA:
Co-payments for prescription drug co-pays are allowed to be reimbursed through the HRA but are subject to specific IRS guidelines.
If you are enrolled in both an FSA Medical Expense Account and an HRA:
IRS rules require prescription drug co-pays to FIRST be reimbursed from your FSA. After the FSA is exhausted, pharmacy co-pays may be submitted to your HRA for reimbursement.
If you are enrolled only in an HRA:
Prescription drug co-pays may be submitted directly to your HRA for reimbursement.
What if I don't use all my HRA money before the end of the year?
If you do not use all the money in your HRA before the end of the plan year, and you re-enroll in a CDH plan in 2009, unused monies automatically roll over and are added to the next year's new HRA amount. Any unused monies continue to roll over until they are vested.
When are monies actually “rolled over”?
Unused HRA monies are subject to a 90 day run out period to allow for all prior year claims to be paid. No later than 30 days after that date, unused HRA monies from the previous year are added to the employee's HRA balance for the current year. Upon separation all vested monies are invested in a Retirement Health Savings Account per plan guidelines.
What if I use all my HRA money before the end of the year?
You would continue to use the CDH health plan just like a regular plan and be responsible for any out of pocket expenses up to the maximum limit.
How do I get reimbursed from my HRA account?
The County has engaged a Third Party Administrator, Fringe Benefits Management Company (FBMC), to administer the HRA portion of this health plan.
HEALTH CLAIMS
In order to receive reimbursement you must complete an HRA claim form, attach a copy of your Explanation of Benefits (EOB) from VISTA to show you incurred a covered expense and mail or fax it to FBMC. All health claims require an EOB from the health carrier, even if covered services are provided out-of-network.
PHARMACY CLAIMS
For pharmacy co-pay reimbursements, attach a copy of your itemized pharmacy receipt showing your name, date, and prescription information and mail or fax it to FBMC. Reimbursements are made on a daily cycle. You may also elect direct deposit for reimbursement to expedite payments to you.
| Incur medical expense, file claim with AvMed or VISTA |
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Receive Explanation of Benefits (EOB) from AvMed or VISTA |
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Complete HRA Claim Form, attach EOB and send to Fringe Benefits for reimbursement |
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Receive check or direct deposit up to value of HRA account. |
Can I receive reimbursement from both my HRA account and FSA Medical Expense Account for the same expense?
No, the IRS does not allow duplicate reimbursement.
Health Expenses:
All eligible CDH health expenses must FIRST be reimbursed through your HRA. If you have an FSA Medical Expense Account, reimbursement can be made after your HRA allowance has been exhausted. Any FSA Medical Expense Account requests sent to Fringe Benefits for eligible CDH claims before your HRA is exhausted will automatically be transferred to the HRA and reimbursement will come from that account. Once exhausted, claims can be reimbursed from the FSA Medical Expense Account.
All health claims, including out-of-network and non-covered claims, require an Explanation of Benefits (EOB) from the health carrier before the claim can be paid from the HRA or FSA account.
HRA Claim Form -- (PDF)
FLEXIBLE SPENDING ACCOUNTS (FSA)
CLICK HERE TO COMPLETE A TAX-SAVINGS ANALYSIS.
A Flexible Spending Account (FSA) lets you set aside dollars from your pay check before taxes are calculated, saving you taxes on the amount you elect under the program. When you incur eligible expenses, you submit claims and are reimbursed for the eligible expenses, tax-free. Flexible Spending Accounts are permitted under Section 125 of the Internal Revenue Code. The County's Cafeteria Benefit Plan offers two types of accounts; Medical Expense and Dependent Care. You may establish one or both accounts, depending on your need. 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 or dependents of a domestic partner cannot be reimbursed under a spending account.
USE IT OR LOSE IT RULE
FSA accounts are subject to the IRS “Lose it or use it rule”. Unreimbursed amounts left in the Account cannot be returned to you. Claims must be incurred prior to 12/31/07 and submitted to FBMC by 03/31/08. Under IRS regulations, unclaimed amounts are forfeited. For this reason we encourage you to be conservative in your estimates and only consider expenses you will incur in 2007.
| The deadline to submit receipts for expenses incurred in 2007 is March 31, 2008. |
MEDICAL EXPENSE FSA
You can be reimbursed, tax free, from your Medical Expense FSA for health care expenses not covered or only partly covered by your health, pharmacy, dental or vision plan. If an expense is valid according to IRS guidelines, the expense is reimbursable from your Medical Expense FSA. The expense can be incurred by you, your spouse, or eligible dependent children or other tax-qualified individuals. You cannot be reimbursed for an expense under your Medical Expense account AND claim it on your income tax return nor can you receive reimbursement from both your FSA and HRA account. Expenses incurred by a domestic partner or dependent of a domestic partner CANNOT be reimbursed through the Medical Expense Account unless the person meets the IRS definition of dependent for tax purposes. You do not need to be enrolled in any other County insurance program to participate in this program.
Which Expenses Are Reimbursable?
Expenses that the Internal Revenue Service deem eligible can be reimbursed. This includes deductibles, co-payments and co-insurance for services and some over-the-counter medicines. The service must be performed/received during the Calendar Plan Year (January 1 – December 31, 2007) and while you are actively participating. Please review the list of eligible expenses in the Flexible Benefits Plan handbook included in your enrollment packet or call Fringe Benefits Management Co. (FBMC) at 800-342-8017.
IMPORTANT : For Medical Expense FSAs– Any time after January 1 you are eligible to claim expenses up to your calendar year election amount and be reimbursed when you submit eligible expenses with the required documentation. You then continue to have your bi-weekly contribution amount deducted from your payroll check.
Which Expenses Are Not Reimbursable?
The following is a partial listing of services or expenses that are not reimbursable under a Medical Expense FSA. For more information, call FBMC.
- 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.
Claims for Orthodontia Orthodontia expenses are treated differently from other health care expenses under a Medical Expense FSA. For all other benefits, you and/or your eligible dependent(s) must have actually received the services in order to be reimbursed. For orthodontia, you do not need to have received the full series of services, you and/or your eligible dependent(s) only need to submit a treatment plan, have begun treatment and have signed a contract for the planned orthodontia services. Eligible expenses will be reimbursed upon submission of the required documentation.
DEPENDENT CARE ACCOUNT
If you enrolled in the FSA Dependent Care Account, you can be reimbursed, tax free, for dependent care expenses if you meet one of the following criteria and your dependent spends at least eight hours a day in your home and the dependent meets the IRS definition of a dependent. You are eligible for a Dependent Care FSA if you:
- Incur day care expenses so you can work or look for work. This includes summer day camp, day care, and after-school care that allows you to work
- Are married and you incur day care expenses so you can work full time and your spouse can work or go to school full time
- Incur day care expenses so you can work full time and your spouse is incapable of self-care
MEDICAL EXPENSE AND DEPENDENT CARE ACCOUNT CLAIM PROCESSING
How To Get Reimbursed For Eligible Expenses
- Receive eligible services and incur the expense.
- Mail or fax a correctly completed FSA Reimbursement Request Form along with one of the following:
- An Explanation of Benefits (EOB) from your health or dental insurance provider that shows the specific type of service you received, the date and cost of the service and any uninsured portion of the cost
- A receipt, invoice or bill from your health, pharmacy or dental care provider listing the date you received the service, the cost of the service, the specific type of service (if not covered by insurance) and the person for whom the service was provided for (if enrolled in a CDH plan with an HRA, you must submit an EOB, itemized receipts will not be accepted)
- If services could be deemed cosmetic in nature, a written statement from your healthcare provider indicating the service was medically necessary accompanied by the receipt, invoice or bill for the service.
- FBMC will mail you, or direct deposit to your designated bank account, a reimbursement of qualified expenses during the next daily reimbursement period following receipt of your correctly completed Reimbursement Request.
FSA Claim Form -- (PDF)
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