Health Care Flexible Spending Account (General Purpose)


You may contribute up to $5,000 a year to the Health Care Flexible Spending Account (FSA) if your medical plan is one of the following:

At the time you enroll, you must choose from two payment options:

  1. Health Care Flexible Spending Account – Debit Card With this payment option, you will receive a debit card which can be used to pay for eligible expenses. You can also choose to file a claim for reimbursement. In either case IRS regulations require you to provide substantiation.

  2. Health Care Flexible Spending Account – Auto Pay With this payment option, BCBS of IL and Delta Dental of Kansas will report to PayFlex any eligible expenses that are not covered under the plan. PayFlex will automatically reimburse you for those expenses. No further substantiation is required. If you file a claim outside of the Auto Pay process, you will be required to provide substantiation.

 

Note: You can elect either the Debit Card or Auto Pay option when you are first eligible or annually during annual enrollment. You cannot change your election mid-year.

 

Qualified expenses eligible for reimbursement with FSAs include:

Note: You may have a medical expense for a child that is not reimbursable under the Health FSA even though such child is covered under the Medical Plan. 

 

Claims Filing Deadline

Claims must be submitted within 12 months from the date of service for medical and dental and 6 months for vision to be considered.  The claims filing deadline for the Health Care Flexible Spending Account (FSA), Dependent Care Flexible Spending Account (FSA), Limited Purpose Health Flexible Spending Account (FSA) is March 31 of the following calendar year for dates of service in the previous calendar year.

 

Flexible Spending Accounts – Claims Substantiation Requirement

Flexible Spending Accounts (FSAs) reimbursements require substantiation to the vendor (PayFlex) from the participant. This is an IRS requirement that vendors are required to follow. Reimbursements from FSAs must be accompanied by the appropriate documentation, typically in the form of a receipt and / or explanation of benefits (EOB). The documentation must indicate whether it is a qualified expense. In many cases, claims provided by the insurance company (BCBSIL or Delta Dental) contain the appropriate information needed. However, in many situations account holders may need to submit additional documentation.

 

Important Tax Information

If you are reimbursed for an expense through your Flexible Spending Account, you cannot claim that expense as a deduction on your federal income tax return.

 

Important Reimbursement Requirements for children over the age of 18 – General Purpose or Limited Purpose Health FSA

While adult children who are younger than age 26 may be enrolled in the Medical Plan even if they do not qualify as your tax dependent, the rules are not changes for the Health FSA. An expense that is incurred to provide medical care for your adult child cannot be reimbursed from the Health FSA unless your child also qualifies as your tax dependent.


Consequently, if you have children who are age 19 or older, but younger than age 26 (and the child is not disabled), please bear in mind that, as a general rule, expenses incurred for their medical care will not be eligible for reimbursement under your Health FSA unless each of the following requirements is satisfied:

 

  1. The child will be under the age of 24 at the end of the calendar year; and
  2. The child is a full-time student; and
  3. The child resides with you for more than one-half of the calendar year (not including “temporary absences” due to special circumstances, such as education); and
  4. The child does not provide more than one-half of his/her own support.

 

The dependent rules can be complicated and special rules can apply in particular situations. This information is merely to help clarify that not all adult dependents covered under the Medical Plan may have their unpaid medical expenses reimbursed by the Health FSA.